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National Needs Assessment of Health Information System to Address Cardiovascular Diseases in Nepal: A Mixed Method
A Shrestha1, S B Parajuli2, A Aryal3
1Department of Community Medicine, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
Insights
High out-of-pocket spending in Nepal disproportionately affects cardiovascular diseases (CVDs). Prioritizing integrated healthcare services and evidence-based budgeting for CVDs is crucial to reduce impoverishment.
Area of Science:
- Health Economics
- Public Health
- Cardiovascular Disease Research
Background:
- Health financing is critical for health system strengthening.
- Nepal faces an epidemiological transition with a rising burden of cardiovascular diseases (CVDs).
- Assessing health financing for CVDs is essential for effective prevention, control, and treatment.
Purpose of the Study:
- To evaluate the healthcare financing landscape for cardiovascular diseases in Nepal.
- To analyze revenue collection, resource pooling, and service purchasing for CVDs.
- To identify gaps and opportunities in financing CVD care.
Main Methods:
- Sequential explanatory mixed-method research design.
- Desk reviews and secondary data analysis of health financing.
- Key-informant interviews with policymakers and experts (February-September 2019).
Main Results:
- Out-of-pocket (OOP) expenditure constitutes 52% of total health expenditure, with two-thirds for non-communicable diseases (NCDs).
- Only 7% of NCD expenditure was allocated to CVDs in fiscal year 2015/16.
- Hypertension is a leading utilized service within the health insurance program for CVDs.
Conclusions:
- High OOP expenditure for CVDs contributes to impoverishment in Nepal.
- Integrating health services and aligning provider payment mechanisms with insurance programs can improve CVD care access.
- Prioritizing evidence-based budgeting for CVDs is essential for the government.
Abstract:
Background Health financing is a major domain of health system building blocks. With the epidemiological transition and increasing trend of Cardiovascular diseases (CVDs), it is crucial to assess the status of health financing to address the gap of prevention, control, and treatment of CVDs in Nepal. Objective This paper aims to assess the situation of healthcare financing on Cardiovascular diseases in Nepal. We framed three key functions of health system financing: (a) revenue collection, (b) pooling of resources, and (c) purchasing of services for this study. Method We used sequential explanatory mixed-method research design. We conducted desk reviews, analyzed secondary data on health financing followed by Key-Informant Interviews with five relevant policymakers and experts between February and September 2019. We obtained the Ethical clearance from the Nepal Health Research Council. Result Out of pocket (OOP) expenditure remains the highest source (52%) of total health care expenditure in Nepal, and two third of it is made for NCDs. Out of total current health expenditure on outpatient and inpatient services for fiscal year 2015/16, only 7% of total NCDs was spent on CVDs. Hypertension is the third-most utilized insurance service out of 36 CVD related services provided by the Health Insurance Board. The existing health related social service schemes covers the high costs associated with treatment, and streamlining these services including provider payment mechanisms with the health insurance program could open up opportunities to expand quality CVD services and make it accessible to the marginalized population. Conclusion Health Financing is the integral part of the health system. With the rising burden of cardiovascular diseases and its impact on impoverishment due to high OOP, integrated health care services, budget specification based on the evidence-based burden of disease such as CVD needs to be prioritized by the government.
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