Poor people can have trouble accessing quality healthcare and buying the drugs they need to maintain health. Some countries are looking for cost-effective ways to provide universal healthcare coverage through subsidized insurance programs, but even then they struggle to get people to sign up. This evaluation studies whether activities to promote healthcare insurance can increase enrollment, while also providing evidence on whether such programs reduce costs.
Research area: Health and Health Systems
Evaluation Sample: 21 households in each of the 300 Village Development Communities
Timeline: 2013 - 2017
Intervention: Subsidized health insurance
Researchers: Tekabe Belay, World Bank; Khabiraj Khanal, Nepal’s Ministry of Health and Population; Manav Batterai, World Bank
Improving the health of poor families requires availability of quality health services and ensuring access and use. Health insurance is a tool that countries often use to make health services more affordable. That of course assumes that health insurance itself is affordable. One approach is to subsidize the cost of insurance to help improve enrollment, but there are questions whether coverage really will make a difference in people’s lives. The evaluation will provide evidence of the impact of providing subsidized health insurance on improving health outcomes and reducing out of pocket expenses on health care. This will give policymakers in other developing countries valuable information for developing and supporting national health insurance plans.
Nepal has seen a sharp rise in out-of-pocket health costs and growing inequality in access to care. Although Nepal has a wide network of public health facilities, only about 50 percent of the poorest Nepalese seek care when they are ill because of problems of access and affordability. Essential drugs that are supposed to be provided free are often in short supply, for example, forcing people to pay out of pocket. The Ministry of Health and Population is piloting a new health insurance program that will cover services and essential medicine. SIEF-supported researchers are partnering with the ministry to evaluate whether this insurance lowers out-of-pocket expenditures and increases use of health service. The results will be used to inform the scale up of this health insurance program.