International Journal of Therapeutic Applications, Volume 10, 2013, 1-6 1 EFFECTIVENESS OF SERVICE DELIVERY IN HEALTH FACILITY WITH AND WITHOUT COMMUNITY HEALTH INSURANCE SCHEME IN NEPAL Lekha Nath Panthi, Hom Nath Chalise, PhD Department of Public Health, Asian College for Advance Studies, Satdobato, Lalitpur, Nepal INTRODUCTION Nepal is a highly heterogeneous country in terms of geography, ethnicity, language and culture. It is land-locked, sharing borders with India and China. It has wide range of distribution of region i.e. Terai (low and plan land), Hilly and Himalayan region. Due to its geography, facilities regarding basic needs along with health services have also got variation. Though the health service in Nepal was started in 1947 on the establishment of Bir Hospital in Kathmandu, up to this 21st century, majority of people of Nepal are still beyond the access of minimum basic health service (Panthi, 2007). Approaches such as community health insurance can in principle help households to avoid being pushed into poverty by unanticipated health costs, but schemes exist in only a handful of districts, and have low coverage in Nepal (NHSP-IP II 2010-2015). Health insurance is relatively new area of economic activity to improve the quality of human life (Tabor, 2005). The concept of health insurance (HI) is not new in Nepal. Health insurance schemes (HIS) are implemented in various models by government and non government organizations. These schemes are confined to a certain pocket of the country. The major health insurances implemented in Nepal are: Community Health Post Based Health Insurance model initiated by united Mission to Nepal (UMN) in 1976 in Lalitpur, Hospital based Micro Social Health Insurance Scheme, initiated by B.P. Koirala Institute of Health Sciences (BPKIHS) in 2000 in Dharan, Health Co- operative model initiated by Public Health Concern Trust (PHECT) in Kathmandu Model Hospital. Recognizing the potential of the programme, the government promulgated the Community Health Insurance Scheme (CHIS) in 2003 (Baral, 2007). CHI is a Pilot Interventions in few Districts of Nepal with different model. Districts PHCC implementing CHI are Mangalabare PHCC in Morang District, Dumkauli PHCC Nawalparasi, Katari PHCC Udayapur, Chandranigahapur PHCC Rautahat, Lamahi PHCC Dang, and Tikapur PHCC Kailali (DOHS, 2067/68). The relationship between health insurance and use of health services persists, even when controlling for other factors, such as age and poverty status. Those with insurance for only part of the previous year and those with no insurance in the preceding year were significantly less likely than those with insurance for the full year to ABSTRACT In Nepal, though the health service started early, majority of the people are still beyond the access of minimum basic health service. Approaches such as Community Health Insurance (CHI) can in principle, help households to avoid being pushed into poverty by unanticipated health costs, but schemes exist in only a handful of districts, and have low coverage in Nepal. This study on Effectiveness of Service Delivery in Health Facility (HF) with and without Community Health Insurance Scheme (CHIS) conducted in Lalitpur Nepal was conducted in two similar type of health facility in which one is implementing CHIS scheme. Data suggested that the knowledge about the CHIS programme was more in the community people where CHIS was implemented. Similarly, the types of services available were more in HF with CHIS in Nepal. No significant difference was observed in behaviour of Health Service Providers (HSP) between two HFs. The flow of clients was more in HF with CHIS. However, the trend of number of household insured in CHIS programme was in decreasing order after the implementation of free health service policy by GoN. Key words: Community Health Insurance, health facility, health service, Nepal Corresponding Author : panthiln@yahoo.com