Comparative Study of Community Based Health Insurance By Cooperative Groups and Public Health Centers in Nepal

Cooperative health is being a model of social enterprises through community based health insurance (CBHI). Theoretically, it was based on Rochade cooperative principles and sickness fund for the accident insurance established... [ view full abstract ]

Cooperative health is being a model of social enterprises through community based health insurance (CBHI). Theoretically, it was based on Rochade cooperative principles and sickness fund for the accident insurance established in Massachusetts, US. CBHI through cooperatives is considered as an effective way to reach the poor people to access appropriate health care services in developing countries. In Nepal, there was started the health insurance as pilot project since 4 decades but no significant results were observed. After the formation of the cooperative health insurance there are substantial outputs and overtake the result of public health insurance. The aim of the study was to compare the output of the health insurance conducted by government health centers and the cooperative groups.

Study Design:

A cross sectional study was performed with all 6 co-operative health institutions and 6 public health centers by key informants interview and reviewing the records.

Population Studied:

We studied the 6 co-operative groups that covered 2152 households and 10,106 person and 6 public health centers who covered 4176 households and 22,691person.

Principal Findings: The cooperative groups established the income generation activities and collected the funds but there was no assurance for economic viability. Subsequently, the cooperative groups applied the contract sign policy with hospital but did not by public health centers. The new enrollment was not increasing because of the individual occupation, household financial situation, quality of care in hospitals etc. in both groups. Enrollment numbers from the disadvantage group, amount of the discounted money during contract, and average time to reach the treatment centers were significantly higher (p<0.05) among cooperative groups than public health centers.

Conclusions: The study concludes that cooperative groups can be the best reference for the universal health coverage campaign by government. Subsidy must be provided to group based on their performance

Implications for Policy or Practice:

The co-operative model of health service delivery is new policy because it can improve the responsiveness towards the people and improve the quality of service. More importantly, it will increase the universal health coverage as a complementary partner with public health institutions.