Out-of-pocket Health Expenditure in Nepal
Abstract: Medical care in Nepal is largely financed by the individual, and although insurance programs and subsidies exist, they are limited in coverage, amount of assistance provided, and level of enrollment. Medical needs that extend beyond basic health services, specifically following acute injury can lead to financial difficulties that may jeopardize the ability to maintain basic needs and can push people into cycles of poverty. Costs for transportation, food, and itemized hospital charges can quickly deplete financial resources and require additional strategies to finance care, often through sale of land, loans, and forgoing of children’s educations. The aim of this study is to both understand strategies that are devised and utilized to finance healthcare following acute medical need and the implications of such strategies. To do so, a qualitative study was conducted in urban and rural Nepal among 10 individuals who experienced acute medical need and consequential high rate of healthcare-related spending. The theoretical framework that guided the study was based on theories of trust, including how trust is generated and exchanged, as well as theory on the male breadwinner, in order to conceptualize the role of men in Nepali society. Finally, theories on social capital, including its significance in enabling relationships between individuals within families and exchanges with members of patients’ local communities were utilized. Results indicate that patients often travel to multiple healthcare facilities before adequate diagnoses are given that address their medical need, leading to significant financial expense, impact on land ownership and land as mechanism for income-generation, disruption to livelihood strategies and children’s educations, and inability to travel abroad as remittance workers. Findings have implications on healthcare-related financing and service care delivery in Nepal.
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