Qualitative evaluation of the health insurance program in Nepal: Expectations beyond limitations

Abstract

The government of Nepal introduced a national health insurance program in 2016 to comply with the constitution and international commitments to ensure universal health coverage by 2030. This qualitative study explores public perceptions and satisfaction concerning the new health insurance program. The study is guided by an interpretive worldview using both in‐depth interviews (IDIs) and focus group discussions (FGDs). Altogether, 34 (28 IDIs and 6 FGDs) events were conducted covering both self‐ and government‐sponsored health insurance enrollees in the new health insurance program. The study found that insurees had larger expectations as well as both favorable and negative perceptions of the program. Positive perceptions included that the program helped to lower the gap between the wealthy and the poor, increase coverage with fewer financial contributions, and make it easier to receive health services financially. Negative perceptions included long waiting times for registration, consultations, laboratory test results, and pharmacy visits, as well as the lack of drugs, inadequate coverage (a low ceiling), low‐quality services, and strict procedures, which combined to make insurees dissatisfied. We noticed that insurees had expectations that went beyond the program's guidelines, such as the expectation that services would be provided without queues and long waits, that additional services and coverage would be provided, and that preference would be shown for patients who lived far from hospitals. Adequate information, education, and communication‐ and process‐related interventions that address these issues may help minimize the insurees' unrealistic expectations and areas of dissatisfaction.