Factors Affecting Nepal Health Insurance Enrollment

Journal Club Presentation
Presented By:
Name: Bikash Dangaura
Roll No: Nine (9)
BPH, VIII Semester, SHAS, PU.
12/3/2020 Bikash Dangaura 1

Presented for the partial fulfillment of requirement
of
PHA 451 Journal Club/Health Seminar
of
Bachelor of Public Health, VIII Semester,
School of Health and Allied Sciences, Pokhara University
under the cardinal supervision of
Assistant Professor Dr. Hari Prasad Kaphle
By
Bikash Dangaura,
17370186,
2016-1-37-0110

Selected Article for Presentation
• Deepak Raj Paudel. Factors Affecting Enrollment in Government
Health Insurance Program in Kailali District. Journal of Nepal Health
Research Council. 2019; Vol 17 (Issue 44): 388-393
• DOI: https://doi.org/10.33314/jnhrc.v17i3.2026

Journal Information
• The Journal of Nepal Health Research Council (JNHRC) is an official,
internationally peer reviewed, Pubmed Indexed, biomedical journal of
the Nepal Health Research Council since 2002.
• It is published every trimester (Every 3 months).
• The Journal publishes articles on various categories like Original
Article, Review Article, Case Report, Viewpoint and Letter to Editor
and Others.

Journal Information
• The aim of JNHRC is to increase the visibility and ease of open access
scientific and scholarly articles thereby promoting their increased
usage and impact.
• It grants the permission to read, download, copy, distribute, print,
search, or link to the full texts of the articles available online.
• Authors do not have to pay for submission, processing or publication
of articles at JNHRC.

Journal Information
Publisher Nepal Health Research Council (NHRC)
SJR Index 0.194 (2019)
Impact Factor Not Available
Citations 78 (2019)
Indexing Indexed and associated with PubMed, Crossref, DOI(Digital Object Identifier), Index Copernicus
International, Scopus, Embase, Google Scholar, Nep Med and SJR
Listed In International Committee of Medical Journal Editors (ICJME) & Nepal Journals OnLine (NepJOL)
ISSN Print ISSN:1727-5482; Online ISSN: 1999-6217
Rejection Rate 25-30%
Editor in Chief Prof. Dr. Ganesh Dangal (Senior Consultant, Department of Obstetrics and Gynaecology, Kathmandu
Model Hospital);
Editors Prof. Jay Narayan Shah (Professor, Department of General Surgery, Patan Academy of Health Sciences,
Lagankhel, Lalitpur),
Prof. Dr. Arun K Neupane (Professor, Department of Paediatrics, Nepalese Army Institute of Health
Sciences, Sanobharyang, Kathmandu),
Prof. Archana Amatya (Professor, Department of Community Medicine and Public Health, IoM, TU)
And 29 more members including National and International Editors

Critical Appraisal of Journal
• It is an open access, peer-reviewed and trimesterly published journal.
• It is the official journal of Nepal Health Research Council.
• The Journal is Indexed and associated with PubMed, Crossref, Digital
Object Identifier (DOI), Index Copernicus International, Scopus, Embase,
Google Scholar, NepMed and SJR.
• The review process is Double Blind Peer Review Process to minimize the
chances of Bias.
• Manuscript submission process is completely online

Tittle of Article
• Factors Affecting Enrollment in Government Health Insurance
Program in Kailali District

Critical Appraisal of Tittle
• The title of the article reflects the topic and the focus of the study.
• The title is indicative towards the research objective and research
question.
• The title is directional towards the study variables also.
• The title is neither too long nor too short.

Authors
• Deepak Raj Paudel (Kathmandu University School of Education,
Lalitpur)
• Doctor of Education/Master of Statistics and Health Research
• 7 Publications, 619 Reads and 12 Citations
• Currently running Project: 1 [Utilization and Health Care
Expenditure: An experience from Health Insurance in Nepal (PhD
Research Project)]
• Skills and Expertise in Health, Health Disparities, Health Inequality,
Health Outcomes, Health Equity, Health Care Management, Health Care
Delivery, PH Education, Health Management and Health Planning
• Current Affiliation: Associate Professor at School of Business,
Pokhara University
• Source: https://www.researchgate.net/profile/Deepak_Paudel5

Critical Appraisal of Authors
• The name of author is clearly mentioned.
• The credentials of author are also clearly mentioned.
• The published article is within the author’s specialty area.
• The author’s current position and area of expertise are also mentioned.
• The authors past experience is not found to be mentioned.

Abstract
• Snapshot of abstract

Critical Appraisal of Abstract
• The abstract of the study is well structured.
• The abstract is fully informative.
• The abstract is self explanatory.
• The information in the abstract matches to the information in the detailed text.
• It is fully comprehensive in the contents.
• It gives the accurate summary of the overall article.

Introduction
• The financial burden of health care is high in Nepal.
• High out of pocket expenditure for health care is major hurdle in achieving universal health
coverage, an explicit target of SDG.
• Health insurance is a mechanism to reduce out of pocket expenditure for health care.
• HI shares financial risk to a large group of population, thus reducing health service induced
poverty.
• The Government of Nepal implemented the SHI program in 2016 from Kailali, Baglung and Illam,
inaugurating from Kailali on 7th April 2016
• This study assessed the determinants of enrollment in SHIP of Government of Nepal in the first
piloted district, Kailali, Nepal.

Critical Appraisal of Introduction
• The article describes the overall background of the study and the history of the SHI
program of Nepal in brief.
• It explains in detail about why the study is needed.
• It has the relevant literatures regarding the topic which are easily accessible.
• The introduction clearly states the objective of the study.
• The article is based upon the existing literatures and their review.
• The introduction has also tried to show the relation between the SHI program of Nepal
and its effect on UHC.

Materials and methods
• Study Setting: Households within the Kailali District
• Study Duration: 1 Month (January to February 2018)
• Study Population: Household Head of 1066 Households from 41 Wards of the District
• Ethical Clearance: Ethical clearance was obtained from NHRC & Pokhara University
Research Center
• Data collection approval was received from SHSDC (Social Health Security Development
Committee)
• The study was approved by Kathmandu University, School of Education

• Sampling Technique: Multi-stage Cluster Sampling (Assuming 50%
proportion of success i.e., p-value, 95% Confidence Interval, 5%
margin of error, 3 as a design effect being multi stage cluster sampling,
and 7.5% as non-response rate)
• Two stage cluster sampling was used (First, 26 wards comprising at
least 10 insured households from a list of wards using lottery method
second, 41 households were randomly sampled from each ward across
the ward office. In each ward, about 25% of the insured household
selected)

• Sample Size: 1066 Households (41 Wards of the District)
• Study Design: Cross-Sectional
• Study Variables: Demographic, Socio-economic, Morbidity status,
Health Service related variables
• Data Collection Tools: Structured Survey Questionnaire developed on
the basis of previous related studies with intensive review

• Data Entry Tool: Census and Survey Processing System (CSPro)
Version 7.0
• Statistical Analysis Tool: STATA 12.0
• Statistical Analysis: Percentage, Pearson’s Chi-squared Test, Binary
Logistic Regression and Odds Ratio

Critical Appraisal of Materials and Methods
Critical Appraisal of Research Design:
• The study design was appropriate as per the research objective.
Critical Appraisal of Sample:
• The sample was representative to the population of interest
• The sampling error is clearly incorporated
• The non response rate was also found to be incorporated

Critical Appraisal of Methods and Materials
• The methods are acceptable and are explained in depth.
• The methods comply with ethical principles and the defense of human
rights.
• For the collection of scientific and reliable data, proper data collection
methods are used.
• During the research process, several variables related to the study are
taken into account.

Results

Critical Appraisal of Results
• The findings are explained in a reasonable and understandable manner.
• Sequential presentation of the information.
• To illustrate the results, tables, charts and graphs are provided.
• Findings are presented in both graphical and textual form.
• The findings are as per the objectives.

Discussion

Critical Appraisal of Discussion
• The discussion was relevant and outlined the significant results of the
report.
• With reasonable comparison, all the relevant results have adequate
explanation and are reasoned properly.
• Similar previous studies showed that poor were less likely to
participate in SHIP, this study showed that poor may not be able to pay
the required contributions to the insurance program.

Conclusion
Conclusion:
• The study concludes that education, economic status, and presence of chronic
illness in the household are the key factors that influence enrollment in the
health insurance.
Recommendations:
• Since education has positive effect on SHIP uptake, thus, policy makers
focusing on health should not neglect the fact that education is itself a
intervention.
• Policy makers need to implement health insurance premium differently based
on income levels to ensure equal access to health care.
• Compulsory HI scheme can make the program financially sustainable.

Critical Appraisal of Conclusion
• The findings are followed by the outcomes acquired and are based on
the purpose and objectives of the research.
• Appropriate suggestions and recommendations are made.
• The conclusion is believable and meaningful.
• The research question has been answered.

References

Critical Appraisal of References
• There are 22 references cited in this article.
• The references are for every citation in the texts and tables of the article.
• Vancouver style of referencing has been followed.
• References are cited as per the recommended guidelines by the journal.
• Cited references are reliable.

Strengths
• Article published in reliable and reputed journal.
• Pre-test of the tools have been performed before applying them in the study.
• Data collectors were trained before mobilizing them into the field.
• Sponsorships, acknowledgements and ethical considerations are also
discussed
• Written or verbal consent were taken from each and every participants
before data collection.

Weaknesses
• This study could not cover the provider’s perspective, so, a qualitative
approach is suggested to capture supply-side factors.
• Due to the cross-sectional nature of the data, causal associations may
not be perfectly inferred.

Overall significance of the article
• The findings are believable.
• The research is based upon the scientific evidences
• The findings can be applied to both the larger or smaller population groups.
• The article has generated new research questions for future in the similar
topics.
• The article is the author’s contribution to the academic society and also for
the health policy makers.

Contribution to My Dissertation
• My dissertation title is- “Enrollment Status and Factors Associated with
Social Health Insurance Among the Households of Bedkot Municipality,
Kanchanpur”
• As my dissertation topic is also based on the Social Health Insurance topic,
this article will be helpful in various ways such as:
• Literature for my research proposal
• Identifying appropriate study design and sampling technique
• Defining study variables
• Designing and finalizing the study questionnaire
• Selecting appropriate tools and techniques for data entry and analysis

New Research Questions Generated
• “Can Income based premium scheme on SHIP help in reducing the
drop out and promote more enrollment in the program?”

Questions?
Quarries?
Suggestions?
Feedbacks?

Thank You!

Factors Affecting Nepal Health Insurance Enrollment

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