Social Health Insurance Program Research Articles

Transforming Lives Through Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY): A Review

Background: The Pradhan Mantri Jan Arogya Yojana (PMJAY) program was created in line with the global goal of Universal Health Coverage (UHC), and aims to ensure everyone has access to quality healthcare services without suffering financial difficulties. In India, over 60% of healthcare spending is still borne by households, and a significant portion of the population lacks any form of health protection coverage. Discussion: The High-Level Expert Group (HLEG) recommended a shift from supply-side healthcare financing to demand-side financing, leading to the introduction of government-sponsored health insurance schemes. To achieve Universal Health Coverage (UHC), the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched following the recommendations of the National Health Policy 2017. The PMJAY program is the world's largest publicly sponsored social health insurance program, delivering comprehensive healthcare services covering primary, secondary, and tertiary care levels. The scheme covers approximately 12 crore households, including more than 50 crore beneficiaries, offering healthcare coverage of up to Rs. 5 lakh per family annually. PMJAY operates nationwide in India, covering all states and union territories except for a few.. Conclusion: To move forward, PMJAY can play a transformative role in the healthcare landscape, integrate with primary healthcare, contribute to economic development, and expand its scope to include more healthcare services.

Migrant children's take‐up of social health insurance: Experimental evidence from China

AbstractThere is mounting evidence on the importance of health insurance for children's health and well‐being. However, many disadvantaged families do not enroll their eligible children in social health insurance programs. This study examines the effectiveness of interventions aimed at increasing social health insurance enrollment for disadvantaged migrant children in Guangzhou, China. We conducted a two‐stage randomized controlled trial with a 3 × 2 design: (1) randomly assigning parents to a control group or one of two treatment groups, where they received digital information on eligibility or eligibility plus comparative benefits and costs; and (2) nudging half of the parents with text message reminders about the enrollment deadline. Informing parents about eligibility alone did not have any impact. However, providing information on eligibility plus comparative benefits and costs increased enrollment in social health insurance in Guangzhou by over 44% (9.4 percentage points). Nudging produced no significant impact. Exploiting treatment group assignment as an instrument for coverage, we were unable to detect any positive effects of having social health insurance in the first year after the intervention.

Willingness to pay for Social Health Insurance and associated factors among Public Civil Servants in Ethiopia: A systematic review and meta-analysis.

The provision of equitable and accessible healthcare is one of the goals of universal health coverage. However, due to high out-of-pocket payments, people in the world lack sufficient health services, especially in developing countries. Thus, many low and middle-income countries introduced different prepayment mechanisms to reduce large out-of-pocket payments and overcome financial barriers to accessing health care. Though many studies were conducted on willingness to pay for social health insurance in Ethiopia, there is no aggregated data at the national level. Therefore, this systematic review and meta-analysis aimed to estimate the pooled magnitude of willingness to pay for social health insurance and its associated factors among public servants in Ethiopia. Studies conducted before June 1, 2022, were retrieved from electronic databases (PubMed/Medline, Science Direct, African Journals Online, Google Scholar, and Web of Science) as well as from Universities' digital repositories. Data were extracted using a data extraction format prepared in Microsoft Excel and the analysis was performed using STATA 16 statistical software. The quality of the included studies was assessed using the Newcastle-Ottawa Scale for cross-sectional studies. To evaluate publication bias, a funnel plot, and Egger's regression test were utilized. The study's heterogeneity was determined using Cochrane Q test statistics and the I2 test. To determine the pooled effect size, odds ratio, and 95% confidence intervals across studies, the DerSimonian and Laird random-effects model was used. Subgroup analysis was conducted by region, sample size, and publication year. The influence of a single study on the whole estimate was determined via sensitivity analysis. To estimate the pooled magnitude of willingness to pay for the Social Health insurance scheme in Ethiopia, twenty articles with a total of 8744 participants were included in the review. The pooled magnitude of willingness to pay for Social Health Insurance in Ethiopia was 49.62% (95% CI: 36.41-62.82). Monthly salary (OR = 6.52; 95% CI:3.67,11.58), having the degree and above educational status (OR = 5.52; 95%CI:4.42,7.17), large family size(OR = 3.69; 95% CI:1.10,12.36), having the difficulty of paying the bill(OR = 3.24; 95%CI: 1.51, 6.96), good quality of services(OR = 4.20; 95%CI:1.97, 8.95), having favourable attitude (OR = 5.28; 95%CI:1.45, 19.18) and awareness of social health insurance scheme (OR = 3.09;95% CI:2.12,4.48) were statistically associated with willingness to pay for Social health insurance scheme. In this review, the magnitude of willingness to pay for Social Health insurance was low among public Civil servants in Ethiopia. Willingness to pay for Social Health Insurance was significantly associated with monthly salary, educational status, family size, the difficulty of paying medical bills, quality of healthcare services, awareness, and attitude towards the Social Health Insurance program. Hence, it's recommended to conduct awareness creation through on-the-job training about Social Health Insurance benefit packages and principles to improve the willingness to pay among public servants.

Willingness to pay for haemodialysis among patients with chronic kidney disease in Abuja, Nigeria

BackgroundEvidence of willingness to pay for kidney replacement therapy is scarce in low-middle-income countries, including Nigeria’s Formal Sector Social Health Insurance Programme. The study, therefore, assessed the willingness to pay for haemodialysis among chronic kidney disease patients in Abuja, Nigeria.MethodsThe study adopted a cross-sectional survey design. We used the contingent valuation method to estimate the maximum stated willingness to pay (WTP) for haemodialysis among end-stage kidney disease (ESKD) patients. We obtained informed written consent from respondents before data collection. The socio-demographic characteristics and willingness to pay data were summarized using descriptive statistics. We evaluated the mean differences in respondents’ WTP using Mann-Whitney and Kruskal-Wallis tests. All variables that had p < 0.25 in the bivariate analysis were included in the Generalized Linear Model (gamma with link function) to determine the predictors of the WTP for one’s and another’s haemodialysis. The level of significance in the final model was ρ < 0.05.ResultsAbout 88.3% and 64.8% of ESKD patients were willing to pay for personal and altruistic haemodialysis, correspondingly. The mean annual WTP for haemodialysis for one’s and altruistic haemodialysis was USD25,999.06 and USD 1539.89, respectively. Private hospital patients were likelier to pay for their haemodialysis (β = 0.39, 95%CI: 0.21 to 0.57, p < 0.001). Patients attending public-private partnership hospitals were less likely to pay for altruistic haemodialysis than those attending public hospitals (β = -1.65, 95%CI: -2.51 to -0.79, p < 0.001).ConclusionsThe willingness to pay for haemodialysis for themselves and others was high. The type of facility ESKD patients attended influenced their willingness to pay for haemodialysis. The findings highlight the need for policies to enhance affordable and equitable access to haemodialysis in Nigeria through pre-payment mechanisms and altruistic financing strategies.

Social Health Insurance Policy of Nepal: Issue of Equity and Equality

The Government of Nepal implemented a social health insurance program (SHIP) in 2016 to achieve Universal Health Coverage. The objective of this paper is to obtain the opinion of the respondents towards the existing premium rate that has been charged to the members of the social health insurance program. The study followed a cross-sectional descriptive study designed. Information was collected from 360 households using the purposive sampling method. The sample was selected among the households who were interested in buying SHIP within a year but till they have not purchased the health insurance policy. A structured questionnaire was used to collect the opinions of the respondents and Chi Square was used to examine the association between the variables. The study concludes that the opinion of respondents towards the equity of premium for SHI is significantly associated with education and profession but not associated with gender, age, caste, health-related training, life insurance policy, agriculture insurance policy, and commercial health insurance. The majority of respondents opined that the premium should be based on the income of the household, as opposed to being equal among those with disparate incomes. The majority of respondents concurred that the current practice of imposing equal premiums on families having dissimilar incomes is unfair.

The Impact of Social Health Insurance on Household Catastrophic Healthcare Expenditures Associated with Chronic Diseases in Sundarharaincha Municipality, Morang

Introduction: Catastrophic health expenditure (CHE) is the condition of paying for health care that exceeds a defined family income or consumption level. Households who spend CHE may have to forego the consumption of other goods essential to their well-being. Chronic diseases require ongoing and often expensive healthcare services and treatments, which can be financially devastating for households without adequate health insurance coverage. Social health insurance programs can provide financial protection and access to healthcare services for individuals and families with chronic diseases. This study aims to assess the impact of the social health insurance program on household catastrophic healthcare expenditures associated with chronic diseases in Sundarharaincha Municipality, Morang.&#x0D; Method: A Retrospective Cross-sectional research design was adopted to collect the data from 424 households by cluster and probability simple random sampling technique. A semi-structured questionnaire was developed based on an intensive literature review. The investigator himself after the approval of the PUSHS- IRC (Purbanchal University School of Health Sciences Institutional review committee) collected data. Before data collection, formal permission was obtained from the Municipality office of Sundarharaincha. Written and verbal consent was obtained from each literate and illiterate household respondent respectively before the interview and observation. The findings were described in descriptive and inferential statistics.&#x0D; Results: The data show that various socio-demographic characteristics are associated with catastrophic healthcare expenditures. A significant impact is seen between social health insurance and catastrophic healthcare expenditures associated with chronic diseases. The majority of the respondents (93.4%) stated that health insurance protects their financial crisis from catastrophic healthcare expenditure. Most (93.7%) of the respondents who expressed reduced economic burden and others as benefits of the enrolment, were compared to health service from specialized hospitals (92.9%) among those who were protected from catastrophic healthcare expenditures by the health insurance program. Similarly, 94.7 % of the respondents said the economic burden was a problem if not enrolled in the health insurance program and 83.3 percent said tension and others as problems if not enrolled. This study also shows that 87.8 percent of the insured respondents who were protected against CHE by the health insurance program had less than 5000 NPR costs per visit (&lt;0.001). Out of the total respondents who were protected against CHE by the health insurance program, 93.6 percent were satisfied with health insurance and 92.9 percent want to continue health insurance in the coming days.&#x0D; Conclusion: By providing adequate coverage and support for households with chronic illnesses, social health insurance could significantly reduce the incidence of catastrophic healthcare expenditure, contributing to poverty reduction and improved health outcomes. Policymakers related to social health insurance program and the concerned government should implement measures to increase health insurance coverage among households having chronic diseases to reduce the burden of healthcare expenditure.

Laos’ Social Health Insurance (SHI) program’s impact on older people’s accessibility and financial security against catastrophic health expense

Laos has introduced various SHI schemes for multiple groups of the population, such as government officials and other population groups under the NHI schemes. There is no specific health insurance policy for this group of people who need special health services and may have a higher possibility of entering financial catastrophe. This study aims to assess the impact of SHI schemes on accessibility and financial catastrophe against catastrophic health expenditures for older people in Laos. A structured questionnaire has been used to retrieve information from 400 older people across 39 villages in Kaysone Phomvihane District, Savannakhet province, the largest province in Laos. In the analytical process, this study used a cross-sectional study design and binary logistic regression models to predict the likelihood of accessing health facilities and experiencing financial catastrophe. The study outcome shows that the increase in age, occupation, number of older people within a household, and presence of chronic conditions increase the likelihood of using health services. Despite the existence of various SHI schemes, this study found that 74 out of 165 households reported using health services experienced catastrophic health expenditure. Several characteristics are associated with catastrophic health expenditure: age, income level, and gender are prone to suffer from catastrophic health expenditure. The difficult problems stem from the absence of comprehensive legislation regarding the older population. Recommendations for policymakers in various timeframes have been made, which cover short- and long-term policy proposals, including providing a specialized lane or fast-track for an older population, building health facilities exclusively for older people, and providing transportation services for older individuals living alone.

Social Health Insurance and Healthcare Seeking Behavior in Urban Ethiopia.

After years of planning, in 2024 the government of Ethiopia proposes to introduce a compulsory Social Health Insurance (SHI) program for formal sector employees. The proposed scheme will provide access to contracted healthcare facilities at a premium of 3% of the gross monthly income of employees with another 3% coming from the employer. Several studies have examined the willingness to pay (WTP) this premium, however, little is known about the healthcare seeking behavior (HSB) of formal sector employees. This paper investigates both - the determinants of healthcare seeking behavior and among other aspects, WTP the premium. Through these explorations, the paper sheds light on the potential challenges for implementation of SHI. Descriptive statistics, logit, and multinomial logit (MNL) models are used to analyze retrospective survey data (2,749 formal sector employees) which covers the major regions of the country. Regarding outpatient care, a majority of the visits (55.9%) were to private healthcare providers. In the case of inpatient care, it was the opposite with a majority of healthcare seekers visiting public sector hospitals (62.5%). A majority of the sample (67%) supported the introduction of SHI but only 24% were willing to pay the proposed SHI premium. The average WTP was 1.6% of gross monthly income. Respondents in the two richest income quintiles were more likely to oppose SHI and consider it unfair. The prominent role of the private sector and the resistance to SHI amongst the two richest income quintiles, suggests that the SHI program needs to actively include private healthcare facilities within its ambit. Additionally, concerted efforts at enhancing the quality of care available at public health facilities, both, in terms of perception and patient-centered care and addressing drug and equipment availability bottlenecks, are needed, if SHI is to garner wider support.

An Inclusive Social Health Insurance for People with Disabilities in Three Southeast Asia Countries: A Systematic Review

This article examines how inclusiveness is implemented for People with Disabilities (PWDs) in social health insurance programs in Southeast Asia by focusing on the National Health Insurance (NHI) in Indonesia, the National Health Insurance Program (NHIP) in the Philippines, and Social Health Insurance (SHI) in Vietnam. The concept of inclusive social insurance for PWDs is used as an analytical tool to explore inclusivity criteria, such as target specifications, service benefits, multi-stakeholder involvement, service functions, and the program's impact. Drawing on the qualitative systematic review method, which refers to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), PRISMA Protocols 2015, and evidence-based guidelines, this article analyzes 25 selected pieces of literature. The results of the study show that: First, there are no special schemes and mechanisms in those programs that target PWDs directly and specifically. Second, those programs have not been able to meet the specific health needs of PWDs. Third, the implementation of those programs has involved three stakeholder actors: the state, the private sector, and NGOs. Fourth, those programs have not shown a significant impact on improving the health quality of PWDs. Finally, it can be concluded that the three programs are not yet truly inclusive in covering PWDs in social health insurance programs.

Social Health Insurance a Key for Universal Health Coverage in Nepal

Social health insurance, which offers financial security and risk sharing for health care expenses, could be the key to achieving Universal Health Coverage (UHC) in Nepal. The social health insurance program in Nepal has advanced significantly, but many adjustments in the insurance mechanism are needed to make it truly a key to UHC.

The Historical Context of the Emergence of Health Systems Science (HSS): Changes in the U.S. Healthcare System and Medical Education from the 1910s to the 2010s.

This study traces the historical process of the emergence of Health Systems Science (HSS) over one hundred years from the 1910s to the 2010s. HSS is a discipline introduced in American medical education as a "third pillar" in addition to basic medical science and clinical medical science. HSS comprises seven core functional domains and four foundational domains, all surrounded by 'system thinking.' According to statistics from 2019 to 2020, 129 universities, or 83.2% of all allopathic and osteopathic medical schools taught HSS before medical clerkship. Additionally, 108 universities, or 69.7% of all medical schools taught HSS during medical clerkship. Although the Progressives in the 1910s sparked discussions about reforming the U.S. national health care system, the National Health Insurance (NHI) debate did not make significant progress from the 1920s through World War II. Efforts to reform the healthcare system gained momentum again in the 1960s. In 1965, a social health insurance program for the elderly called "Medicare" was enacted by revamping the existing social security program. Around the same time, "Medicaid" was also implemented as government-funded health insurance program, distinguishing it from Medicare-a mix of social insurance and government assistance. During the Clinton presidency in the 1990s, political efforts to achieve the NHI by enacting the Health Security Act eventually failed. Almost twenty years later, President Barrack Obama passed the Patient Protection and Affordable Care Act, or ObamaCare, in March 2010. The primary objectives of ObamaCare were to increase the number of insured Americans and reduce health care costs. Post-ObamaCare reforms to the healthcare payment system and changes to the healthcare delivery system have prompted a transformation of the healthcare landscape. The healthcare industry has been pursuing the "triple aim": improving patient experience and population health while reducing costs. To achieve these goals, exposure to a systems-based healthcare environment was necessary. From the 1910s to the 1960s, the model of the ideal physician was the "sovereign physician," who could perform all tasks unilaterally. During this time, doctors were autonomous, independent, and authoritative, and in control of all medical activities. This model was very useful until the mid-twentieth century, when there were many acute illnesses, mainly infectious diseases. Abraham Flexner's 1910 report eventually accelerated the formation of a medical education system based on the two pillars of "basic science-clinical science." During the periods of the 1920s and 1940s, medical education underwent a process of professionalization, standardization, and systematization. World War II did not result in significant changes in medical education. The United States, however, was transforming into a very different society from the prewar period for physicians and Americans. The "New Deal" and World War II led to an expanded role of the federal and state governments in the post-war years. The demand for healthcare was also growing, and the right to healthcare was seen as a fundamental right of all citizens. In the 1960s and 1970s, the current U.S. medical education system was established. Four years of medical school, an internship, and a residency before taking the board examination became the institutional requirements. In the 1980s and 1990s, 'managed care,' represented by Healthcare Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), placed strong controls on both doctors and hospitals (academic healthcare centers). Under the managed care system, academic healthcare centers financially struggled. Moreover, the learning environment on the wards was eroded by shorter patient stays and increased outpatient visits. Since the late 1990s, many medical education organizations, including the Council on Graduate Medical Education (COGME), have called for dramatic reforms to the knowledge and skills of physician education to restore a sustainable U.S. healthcare system. Since 2000, the basic framework of HSS, such as patient safety and value-based healthcare, has been developed. In summary, U.S. healthcare reform efforts since the 1960s-including the expansion of health insurance, managed care and managed competition, and ObamaCare-have led to changes in medical education.

Cost of wound dressing: Implication for enrollment into the National Health Insurance scheme, Nigeria.

Enrollment into the National Health Insurance scheme (NHIS) still poses a challenge in Nigeria despite the established Group, Individual and Family Social Health Insurance Programme (GIFSHIP) during the coronavirus disease 2019 (COVID-19) pandemic. This study examined the direct cost of wound dressing and enrollment into the health insurance scheme among hospitalised patients. A descriptive cross-sectional research design was utilised to investigate the cost of wound dressing and enrollment into health insurance scheme among hospitalised patients in three selected hospitals of South-West Nigeria. The study was conducted from March 2021 to June 2021, and 190 patients were recruited via an interviewer-administered questionnaire. Ethical approvals were obtained from the hospitals while COVID-19 preventive protocols and ethical principles of autonomy, confidentiality and non-maleficence were observed. Majority of the respondents (91%) were not on any healthcare insurance scheme, only 4.2% were enrolled in NHIS while over 70% could not personally pay for their wound dressing. The minimum average cost of wound dressing materials per week and per acute care episode was ₦10 000.00 (Nigerian naira) and ₦50 000.00, respectively, while the minimum average cost for hospitalisation per week and per acute care episode was ₦18 000.00 and ₦130 000.00, respectively, ($1.00 equaled ₦600.00, June 2022). A lack of health insurance coverage is a precursor of 'out of pocket' payment. A political will is required to scale up enrollment of the indigenous population into the NHIS in Nigeria.Contribution:Many hospitalised patients are not enrolled in the NHIS and they are at a higher risk of catastrophic healthcare expenditure.

“It is like an umbrella covering you, yet it does not protect you from the rain”: a mixed methods study of insurance affordability, coverage, and financial protection in rural western Kenya

Countries in Sub-Saharan Africa are increasingly adopting mandatory social health insurance programs. In Kenya, mandatory social health insurance is being implemented through the national health insurer, the National Hospital Insurance Fund (NHIF), but the level of coverage, affordability and financial risk protection provided by health insurance, especially for rural informal households, is unclear. This study provides as assessment of affordability of NHIF premiums, the need for financial risk protection, and the extent of financial protection provided by NHIF among rural informal workers in western Kenya.Methods We conducted a mixed methods study with a cross-sectional household survey (n = 1773), in-depth household interviews (n = 36), and 6 focus group discussions (FGDs) with community stakeholders in rural western Kenya. Health insurance status was self-reported and households were categorized into insured and uninsured. Using survey data, we calculated the affordability of health insurance (unaffordability was defined as the monthly premium being > 5% of total household expenditures), out of pocket expenditures (OOP) on healthcare and its impact on impoverishment, and incidence of catastrophic health expenditures (CHE). Logistic regression was used to assess household characteristics associated with CHE.Results Only 12% of households reported having health insurance and was unaffordable for the majority of households, both insured (60%) and uninsured (80%). Rural households spent an average of 12% of their household budget on OOP, with both insured and uninsured households reporting high OOP spending and similar levels of impoverishment due to OOP. Overall, 12% of households experienced CHE, with uninsured households more likely to experience CHE. Participants expressed concerns about value of health insurance given its cost, availability and quality of services, and financial protection relative to other social and economic household needs. Households resulted to borrowing, fundraising, taking short term loans and selling family assets to meet healthcare costs.Conclusion Health insurance coverage was low among rural informal sector households in western Kenya, with health insurance premiums being unaffordable to most households. Even among insured households, we found high levels of OOP and CHE. Our results suggest that significant reforms of NHIF and health system are required to provide adequate health services and financial risk protection for rural informal households in Kenya.

Insurance-based disparities in breast cancer treatment pathways in a universal healthcare system: a qualitative study

BackgroundThe influence of healthcare system factors on treatment pathways for breast cancer has been studied extensively in lower-middle-income countries (LMICs), but in upper-middle-income countries (UMICs), this area is understudied. This article focuses on the experiences of breast cancer patients in Türkiye, a UMIC with a universal healthcare system. It explores variations in treatment pathways based on the type of health insurance provider (private or state).MethodsThe study uses an exploratory qualitative method based on in-depth interviews with 12 breast cancer patients. The inclusion criteria were Turkish nationality, female gender, and having received treatment from a private hospital within one year of the interview. A purposeful sampling strategy was employed to recruit patients who had either social health insurance only or who had private health insurance in addition to their social health insurance. A two-stage thematic analysis of the interview data was conducted. First, we examined whether the type of insurance provider makes a difference in treatment pathways; we then identified healthcare system factors that explain these differences.ResultsThe study revealed two distinct pathways to treatment. These differ in terms of financial protection, service coverage, and patients’ sense of equity. Patients with private insurance reported easy access to timely and comprehensive treatment. Those without, however, had to navigate complicated routes to treatment; they generally had to resort to seeking treatment from more than one hospital. We found two healthcare system factors that explained the differences: a failure to fully enforce the mandates of the state’s social health insurance in the private hospital sector and growing reliance on private insurance to gain access to essential services.ConclusionsBased on data from the Turkish case, we conclude that healthcare system factors are indeed influential in shaping treatment pathways for breast cancer in UMICs with universal healthcare. These factors include a failure to fully enforce the mandates of the state’s social health insurance programme in the private hospital sector and a growing reliance on private insurance to gain access to essential services. We note that this contrasts dramatically with the situation in LMICs, where the main factors are low-quality care and shortages of medical staff, medicines, and technologies.

The Impact of Health Maintenance Organizations in the Implementation of the Nigeria National Health Insurance Scheme in the Federal Capital Territory (Abuja), Nigeria.

The activities of Health maintenance organizations (HMO) are central to the achievement of universal health coverage. This study sought to examine the number of HMOs actively operating in the FCT and to determine whether the HMOs are promoting or inhibiting universal coverage and proffer recommendations for the overall progress of the scheme. A descriptive prospective cross-sectional study design was used and mixed (qualitative and quantitative) methods A pre-tested interviewer-administered questionnaire make was used to collect quantitative data while qualitative data were collected through a review of literature and in-depth interviews to examine the roles of HMOs from stakeholders' points of view. A total of 250 participants comprised predominantly 230 enrollees into three major programs of the NHIS that is the formal sector social insurance program (FS-SHIP), tertiary institution social health insurance program (TI-SHIP), and community-based social health insurance program (CB-SHIP). The remaining 20 (twenty) enrollees comprised NHIA desk officers, HMO managers, community-based representatives, and healthcare providers. The majority of the respondents (64.8%) reported a high level of awareness of the knowledge of NHIS, while fewer than 19% indicated a lack of awareness as compared to 17% who did not respond to the question. Similarly, most of the respondents (62.2%) reported having satisfactory knowledge of the structure-function modalities of HMOs, while 20.4% were not aware of the mode of operation of HMOs.Contrasting contributions of HMOs to NHIS implementation, approximately half of the respondents (50%) reported dissatisfaction. Likewise, about 50% of the study subjects were of the view that HMOs are not putting the desired commitment towards achieving this goal of universal health coverage. The report from the in-depth interview reiterated that the enrollees were not well satisfied due to the perceived poor and inadequate operational mechanisms of both the HMOs and NHIS. The study revealed a high level of awareness of the knowledge of NHIS and good working knowledge of the structure and function of the HMOs. However, this study demonstrated a low understanding of the working interactions between the NHIS and HMO, among the respondents. Understanding HMOs and how they work is critical for choosing a health plan during open enrollment, hence, there is a need for more client enlightenment.

Effectiveness of Social Health Insurance Program in Nepal: Challenges and Recommendations

The article explores into the concept of health insurance in Nepal as a means of financial protection against unexpected medical expenses. It outlines commitment to providing fundamental health care as a citizen's right and the challenges faced in Nepal to achieving this goal. The study highlights the initiation and expansion of the Social Health Insurance Program, marking to suggestion financial security to individuals and families during illness. Despite progress, economic, social, and institutional barriers hinder many citizens' access to adequate health services. The paper emphasizes the importance of health insurance for low and middle-income families, addressing concerns of economic hardship due to healthcare costs. Challenges in the implementation of the program are discussed, including issues related to organizational systems, service delivery, infrastructure, and budgetary constraints. The need for collaboration between government bodies, quality improvement in healthcare facilities, and better management of health workers is emphasized. The successful implementation of health insurance in Nepal is seen as a pivotal step towards achieving universal health coverage, alleviating financial burdens on citizens, and contributing to national development goals and international commitments.

Effective communication approaches as tool for achieving Universal Health Coverage through social health insurance in Nigeria.

National Health Insurance Scheme (NHIS) designed various Social Health Insurance programmes to achieve universal coverage in healthcare delivery in the country. The Scheme is adjudged to have failed to achieve its primary objective, especially in the informal sector, due to communication lapses. This study has employed an integrative literature review method to appraise the principles underlying effective health communication, the communication approaches of the NHIS, and recommended plausible alternatives. Media integration, advocacy campaign, social media, domestications of ICTs, communication in multiple languages, and active involvement of communities in the programme were found to imbibe some practical communication principles that can help improve communications to a target audience.

Effective communication approaches as tool for achieving Universal Health Coverage through social health insurance in Nigeria.

National Health Insurance Scheme (NHIS) designed various Social Health Insurance programmes to achieve universal coverage in healthcare delivery in the country. The Scheme is adjudged to have failed to achieve its primary objective, especially in the informal sector, due to communication lapses. This study has employed an integrative literature review method to appraise the principles underlying effective health communication, the communication approaches of the NHIS, and recommended plausible alternatives. Media integration, advocacy campaign, social media, domestications of ICTs, communication in multiple languages, and active involvement of communities in the programme were found to imbibe some practical communication principles that can help improve communications to a target audience.

Impact of User and Service Provider Related Variables on Utilisation of Tertiary Institution Social Health Insurance Programme (TISHIP) in the University of Uyo, Nigeria

Impact of User and Service Provider Related Variables on Utilisation of Tertiary Institution Social Health Insurance Programme (TISHIP) in the University of Uyo, Nigeria

The Status of Social Health Insurance in Nepal

INTRODUCTION: Social health insurance (SHI) is a risk-sharing method-based health care financing and administration. SHI combines the contributions of people, households, businesses, and the government with people's health hazards. As a result, it shields people from financial and physical hardship and is a generally equitable way to pay for medical care. This study aims to assess the status of social health insurance in Nepal. MATERIALS AND METHODS: The research is based on a review of empirical studies, reports, and data. The Google Scholar search engine was used to locate research publications on health insurance. The Google Scholar Open Database was applied to find the publications using the keywords "health insurance" or "social health insurance in Nepal." All papers that were published before July 2022 were checked for the study. Fifty-seven research papers were discovered during the initial inquiry; five duplicate articles were eliminated, and seven were out of the norm. Finally, 45 research papers and reports were selected for evaluation with the study titled "The status of health insurance in Nepal." RESULTS: This study finds that Madhesh province has poor status (4.63%) of social health insurance and province one has the highest (33.02%) of insured persons in Nepal. Females (52%) insured are higher than males (48%). The population covered by health insurance is seven percent in Nepal. Likewise, the renewal status of social health insurance is poor in Karnali province (50%) and highest in Lumbini province (85%) for the fiscal year 2021/22. CONCLUSIONS: Social health insurance is an effective strategy for fair access to healthcare services. The penetration of social health insurance is low in Nepal. Since the social health insurance program is one of the effective tools for improving the health system in developing nations like Nepal, so the government should speed up its implementation to achieve the goal of universal health coverage and sustainable development goals.