The Nepal Ministry of Health and Population has been working to develop a national health financing strategy in order to realize Nepal's vision of universal coverage. A parallel effort is ongoing to pilot a health insurance that will address rising out-of-pocket health expenditures and increasing lack of coverage for the poor.
The primary objectives of the impact evaluation are to:
1. Evaluate the effectiveness of the health insurance pilot for the at-risk population
2. Conduct a process evaluation of the health insurance to illuminate potential constraints and incentive problems to inform the national scale-up
3. Provide cost analysis data to inform decisions relating to coverage limits and price negotiations and to estimate the cost-effectiveness of results for the national scale-up.
The results of this evaluation will be used to inform the design and implementation of Nepal's national health coverage plan.
This evaluation consists of six treatment districts, where the new health insurance scheme will be rolled out.
The impact evaluation of provision of new health insurance scheme will be primarily based on a randomized enrolment promotion/encouragement design targeted to increase take up rate of the new health insurance product. However, since the feasibility of this method in identifying the impact is highly dependent on the efficacy of the randomized encouragement on the take up of health insurance, a provision also is made to incorporate a quasi-experimental design which could be utilized for assessing the impact in case the randomized encouragement design does not result in sufficient take up differential. Specifically, under such conditions, a matched difference-in-difference design will be used for impact evaluation. Thus, the evaluation will combine both experimental as well as quasi-experimental designs, where the experimental design will be given priority over the quasi-experimental design.
The baseline community and household surveys were conducted between March and May 2014. Encouragement intervention and implementation of the program were done in June-July 2014. The process evaluation was planned for June 2014 - January 2016, and the endline survey should be carried out in February 2016.