Nepal has implemented the Social Health Insurance (SHI) scheme in February 2015, aiming to enhance financial protection through the pre-payment approach as well as risk pooling in the health sector
This study assessed the performance of the SHI scheme in terms of patient satisfaction, impact on service utilization, coverage, and financial viability, and the experience and challenges in the implementation of social health insurance in Nepal. The mixed-method was applied. The study covered three districts: Kailali, Baglung and Ilam. They were the first three districts where the health insurance scheme has been rolled out in the first phase.
Findings showed that the utilization of health services increased after the SHI implementation, especially for the insured persons. Participants recognized and had positive attitudes towards the scheme, for example, SHI is an appropriate option to reduce the financial burden. However, there are issues and challenges in the SHI implementation such as enrollment of vulnerable populations, adequacy, and availability of the resource.