Access to free health-care services for the poor in tertiary hospitals of western Nepal: a descriptive study

Abstract

background:Nepal is an underdeveloped country in which half of the total health expenditure is from out-of-pocket payments. Thus, the Government of Nepal introduced universal free health-care services up to the level of district hospitals, and targeted these services to poor and marginalized people in regional and subregional hospitals. The aim of this descriptive study was to explore the implementation and utilization of free health-care services by the target population (poor and marginalized people) in two tertiary-care hospitals in western Nepal, one with a social care unit (Western Regional Hospital) and one without a social care unit (Lumbini Zonal Hospital). Methods:Medical records maintained by the two hospitals for one Nepali calendar year were collected and analysed, along with information from key informant interviews with staff from each hospital and patient exit interviews.results: Utilization of free health-care services by poor and marginalized people in the two tertiary-care hospitals was suboptimal: only 8.4% of patients using services were exempted from payment in Western Regional Hospital, whereas it was even fewer, at 2.7%, in Lumbini Zonal Hospital. There was also unintended use of services by nontarget people. Qualitative analysis indicated a lack of awareness of free health-care services among clients, and lack of awareness regarding target groups among staff at the hospitals. Importantly, many services were utilized by people from rural areas adjoining the district in which the hospital was situated.conclusion: Utilization of free health-care services by the target population in the two tertiary-care hospitals was very low. This was the result of poor dissemination of information about the free health-care programme by the hospitals to the target population, and also a lack of knowledge regarding free services and target groups among staff working in these hospitals. Thus, it is imperative to implement educational programmes for hospital staff and for poor and marginalized people. Unintended use of free services was also seen by nontarget groups; this suggests that there should further simplification of the process to identify target groups.

Challenges and opportunities towards the road of universal health coverage (UHC) in Nepal: a systematic review

“…More than two-third of the population depend on out-of-pocket expenditure [15], even for simple communicable disease like the Kala-azar, people who are bearing catastrophic medical expenditures [16] due to expensive private care and higher costs for medicines. To address these problems, there are different approaches like community-based health insurance [17], free health services [18, 19], community drug programs and subsidy to disadvantaged and minority populations. However, all of these initiatives have been piloted at different times in the past and have not established a successful model.…”

Service Quality of Public Hospitals in Nepal: A Systematic Review and Meta-analysis

“…Neither the rank correlation nor the regression test indicated any funnel plot asymmetry (p = 1.0000 and p = 0.5672, respectively). (13) Service quality, customer satisfaction, and repurchase intentions are also studied. The study shows that patient needs and service expectations differ.…”

Age-appropriate vaccination coverage and its determinants in children aged 12–36 months in Nepal: a national and subnational assessment

“…The recent increase in number of measles and tuberculosis cases in Nepal could be attributed to untimely vaccination in Nepal [ 17 , 28 ]. The reasons behind the low age-appropriate vaccines coverage rate might include lack of awareness about the immunization schedule, hard to access health care facilities, reluctancy in administering vaccines, hesitancy of parents regarding vaccination, insufficient infrastructure to transport and store the vaccine in hard to reach areas, and occurrence of unusual events such as natural disaster, disease outbreak (pandemic situation) [ 20 , 26 , 27 , 29 – 33 ].…”

“…Use of mobile phone/smart phone (mhealth) to improve the knowledge and awareness about vaccination and immunization schedule could be an effective way [ 42 , 43 ]. In case of Province 6, low age-appropriate coverage could be due to hard to reach terrain, lack of awareness about the immunization schedule, lack of sufficient infrastructure such as transportation and storage facilities, and lack of human resource in health sector [ 32 , 33 ]. Use of drones technology to transport vaccines in hard to reach areas could solve the problem in these regions [ 44 ].…”