Ranabhat Chhabi Lal, Kim Chun-Bae, Singh Dipendra Raman, Park Myung Bae
Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju, South Korea.
Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea.
Front Public Health. 2017 Sep 22;5:250. doi: 10.3389/fpubh.2017.00250. eCollection 2017.
There are different models for community-based health insurance (CBHI), and in Nepal, among them, the government and the local communities (co-ops) are responsible for operating the CBHI models that are in practice.
The aim of this study is to compare the outcomes in relation to benefit packages, population coverage, inclusiveness, healthcare utilization, and promptness of treatment for the two types of CBHI models in Nepal.
This study was an observational and interactive descriptive study using the concurrent mixed approach of data collection, framing, and compilation. Quantitative data were collected from records, and qualitative data were collected from key informants in all 12 CBHI groups. Unstructured questionnaires, observation checklists, and memo notepads were used for data collection. Descriptive statistics and the Mann-Whitney test were used when appropriate. Ethically, written informed consent was obtained from the respondents who participated in the study, and they were told that they could withdraw from the study anytime.
The study revealed the following: new enrolment did not increase in either group; however, the healthcare utilization rate did (Government 107% and co-ops 137%), while the benefit packages remained almost same for both groups. Overall, inclusiveness was higher for the government group. For the CBHI co-ops, enrollment among the religious minority and the discount negotiated with the hospitals for treatment were significantly higher, and the promptness in reaching a hospital was significantly faster ( < 0.05) than that in the government-operated CBHI.
Findings indicate that CBHI through co-ops would be a better model because of its lower costs and ability to enhance self-responsiveness and the overall health system. Health insurance coverage is the most important component to achieve universal health coverage.
社区医疗保险（CBHI）有不同模式，在尼泊尔，政府和当地社区（合作社）负责运营实际推行的CBHI模式。
本研究旨在比较尼泊尔两种CBHI模式在福利套餐、人口覆盖率、包容性、医疗保健利用率和治疗及时性方面的成果。
本研究是一项观察性和交互式描述性研究，采用数据收集、构建和汇编的并行混合方法。定量数据从记录中收集，定性数据从所有12个CBHI组的关键信息提供者处收集。使用非结构化问卷、观察清单和备忘笔记本进行数据收集。在适当情况下使用描述性统计和曼-惠特尼检验。在伦理方面，获得了参与研究的受访者的书面知情同意，并告知他们可以随时退出研究。
研究揭示了以下情况：两组的新参保人数均未增加；然而，医疗保健利用率有所提高（政府组为107%，合作社组为137%），而两组的福利套餐几乎保持不变。总体而言，政府组的包容性更高。对于CBHI合作社，宗教少数群体的参保人数以及与医院协商的治疗折扣显著更高，而且到达医院的及时性明显更快（<0.05），高于政府运营的CBHI。
研究结果表明，通过合作社实施的CBHI可能是更好的模式，因为其成本较低，且能够增强自我响应能力和整体卫生系统。医疗保险覆盖是实现全民健康覆盖的最重要组成部分。
