Health Service Utilization and Out-of-Pocket Expenditure among the Social Health Insurance Policy Holders in Kaski District, Nepal

Introduction: Nepal has a low health service utilization among the people where ten percent of people face the burden of catastrophic health expenditure and spends more than 10.71% of the total household on health facilities. To reduce Out-of-Pocket expenditure (OOPE) and to improve the access and utilization of health services, Social Health Insurance Program could be a vital health financing mechanism. Objectives: This study aims to assess the status of health service utilization and percent of household expenditure of respondents (OOPE) insured through the Social Health Insurance Program in Kaski district. Methods: A descriptive cross-sectional survey was conducted among 210 sampled people of Kaski district who were enrolled in National Social Health Insurance. The study was conducted from June to December 2018 to assess the level of health service utilization and out-of-pocket expenditure among the insured population. Results: Out of 210 participants enrolled in the Social Health Insurance program, four-fifth (80.5%) participants had utilized the services. Out-of-pocket expenditure for healthcare was 69 percent despite being insured through SHI. There was no statistical relationship observed between socio-demographic characteristics and health service utilization. However, socio-demographic variables such as sex, types of family, number of elderly members in the family were significantly associated with out-of-pocket expenditure among participants. Conclusion: Majority of participants had utilized health services after buying SHI. Out-of-pocket expenditures have been decreased in the treatment and diagnosis of the diseases but not in medicine cost. There is a need for further study with larger sample size and population coverage to have a better understanding of the effectiveness and effect of the Social Health Insurance Program over Health Service Utilization and Out-of-Pocket expenditure.