Management Investigation and Dissertation MN6P00NI

Assessment Details

MN6P00NI Management
Module Code and Title
Investigation and Dissertation
Course Title BA (Hons) Business Administration
Level Level 06
Cohort Autumn 2021
Credit Year long
Component # Comp 003
Weight 60%
Dissertation (Individual Coursework-
Assessment Title
5000 words)
Module Lecturer Mr. Saroj Wagle

Submission Details

Student’s Name/s University ID

Prakash Bk 19032005
Management Investigation and Dissertation MN6P00NI

Date of submission (DD-MM-

28th April, 2022
YYYY)
Word count #
Management Investigation and Dissertation MN6P00NI

Acknowledgment

First of all, I would like to express immense gratitude to all who contributed in one
way or another to enable the victorious completion of this research. I am grateful to
a number of individuals that without their assistance, this work would have not seen
completed.
Firstly, I am indebted to my module leader Mr. Saroj Wagle who was generous with
his time in providing me with valuable guidance, comments, and suggestions which
helped much in producing the report. Secondly, I would to offer my sincere
appreciation to ICP (Informatic college Pokhara) for providing all these learning
opportunities.
I am really grateful to the management of the ‘Western regional hospital’ for the
provision of their full support in the conducting of my research at their hospital. The
management of the hospital played an important role in providing out the needed
respondents’ who provided required data in the answer of the research question.
Finally, Last but not the least, I would like to thank my friends and family, because
it would not have been possible to complete this report without their support.
Management Investigation and Dissertation MN6P00NI

Contents
Research Title ...................................................................................................................... 1
Chapter: Introduction ........................................................................................................... 1
1.1)Background ............................................................................................................... 1
1.2) Statements of problems ............................................................................................ 2
1.3) Research questions ................................................................................................... 2
1.4) Research Objectives ................................................................................................. 3
1.6) Significance of the study .......................................................................................... 3
1.7) Organization of Study .............................................................................................. 3
Chapter 2: Literature review ................................................................................................ 4
2.1) Theoretical review .................................................................................................... 4
2.1.1) Bamako Initiative .............................................................................................. 4
2.1.2) Donabedian model ............................................................................................ 4
2.2) Concept of the effectiveness of GHI ........................................................................ 5
2.3) Some Factors influencing the Effectiveness of GHI ................................................ 5
2.3.1) Premium and Subsidies ..................................................................................... 5
2.3.2) Risk Coverage ................................................................................................... 6
2.3.3) Availability of Health care service .................................................................... 6
2.4) Empirical Review ..................................................................................................... 6
2.5) Conceptual framework ............................................................................................. 7
2.6) Operationalization of the Conceptual framework .................................................... 8
Chapter 3: Research Methodology ...................................................................................... 9
3.1) Research design ........................................................................................................ 9
3.2) Population of Study .................................................................................................. 9
3.3) Sample Frame ......................................................................................................... 10
3.4) Sampling Techniques ............................................................................................. 10
3.5) Data collection technique ....................................................................................... 10
3.5.1) Primary data source ......................................................................................... 10
3.5.2) Secondary data source ..................................................................................... 11
Management Investigation and Dissertation MN6P00NI

3.6) Data Analysis Technique ....................................................................................... 11

3.7) Reliability of the research ...................................................................................... 12
3.8) Validity of the research .......................................................................................... 12
3.9) Ethical consideration .............................................................................................. 13
Chapter 4: Data Analysis and Discussion ......................................................................... 13
4.1) Introduction ............................................................................................................ 13
4.2) Demographic Characteristics of the respondents ................................................... 14
4.2.1) Distribution of respondent’s gender. ............................................................... 14
4.2.2) Categories of respondents by age .................................................................... 16
4.2.3) Education level of respondents ....................................................................... 17
4.2.4) Monthly income of respondent’s family ......................................................... 18
4.2.5) Work status of the respondents ....................................................................... 19
4.2.6) Respondents’ awareness regarding health insurance ...................................... 20
4.2.7) Respondents means of awareness regarding ................................................... 21
4.3) Descriptive statistics of variables ........................................................................... 22
4.4) Correlation analysis ................................................................................................ 23
4.5) Hypothesis .............................................................................................................. 24
4.6) Discussion on each finding .................................................................................... 25
Chapter 5: Conclusion and recommendation .................................................................... 26
5.1) Conclusion .............................................................................................................. 26
5.2) Recommendation .................................................................................................... 27
5.2.1) Drugs and equipment availability ................................................................... 27
5.2.2) Communication service and working environment ........................................ 27
5.3) Limitation of the Study .......................................................................................... 28
References ......................................................................................................................... 30
Appendix ........................................................................................................................... 33
Survey questionnaires .................................................................................................... 33
Gantt Chart .................................................................................................................... 36
Proposed budget ............................................................................................................ 37
Reliability and validity testing output ........................................................................... 38
SPSS Output .................................................................................................................. 39
Management Investigation and Dissertation MN6P00NI

Recommendation letter .................................................................................................. 44

Supervisor meeting Document ...................................................................................... 45
Management Investigation and Dissertation MN6P00NI

Table of Figure
Figure 1: Conceptual framework ......................................................................................... 7
Figure 2:Graph to show the gender of the respondents ..................................................... 15
Figure 3: Graph of the respondent’s age ........................................................................... 16
Figure 4: Graph of the respondent’s education level ........................................................ 17
Figure 5: Graph of the monthly income of the respondents family. ................................. 18

Table of Tables
Table 1: table to show operationalizations of the Conceptual framework .......................... 9
Table 2: Table to show the gender of respondent.............................................................. 15
Table 3: table to show the age of the respondents ............................................................. 16
Table 4: table to show the education level of the respondents .......................................... 17
Table 5: table to show the monthly income of respondent’s family ................................. 18
Table 6: table to show Descriptive statistics of variable ................................................... 22
Table 7: table to show the correlation between variables ................................................. 23
Management Investigation and Dissertation MN6P00NI

Abstract
The paper aims to observe the effectiveness of Government health insurance among people in the
case of Pokhara Academic of Health science (Gandaki Regional hospital). The study has followed
a case study research design. the study developed specific research objectives and they were
accomplished with the research question. The study population involved Government health
insurance policyholders and providers. Two sample categories were used: interview sample and
questionnaire sample. The interview sample involved five people who provide Government health
insurance at Gandaki regional hospital. The questionaries sample involved 125 randomly selected
respondents, who have used Government health insurance services at least once. then data have
been obtained administering structured among 125 Government health insurance policyholders.
The collected from survey analyzes through Descriptive statistics and correlation using SPSS
output.

The research findings show that, the majority of the customers were not satisfied with the health
care services provided to them by GHI provider. They claimed that the provision of health care
services was so limited, including: poor supportive facilities, absence of specialized health care
services, unsatisfactory number of service providers, poor laboratory services as well as the
absence of some prescribed medicines/drugs from the aligned hospital.

The conclusion was made via the usage of respondents’ views and opinions. The study involved
documentation, thematic analysis and narrative presentation. The themes emerged from the
interview and documentary transcripts were documented and their meanings assigned in relation
to the research objective and questions. A number of direct quotes which show dissatisfactions
have been presented in the analysis chapter. The findings indicate a number of limitations facing
GHI members during their treatment at the hospitals.

The study recommends: hospitals to incorporate government in hiring more staffs so as to

solve the problem of shortage of service providers, working environment should be
improved, government to ensure drugs and equipment to be available at all hospitals and
communications systems should be improved, as it was noted that there is the gap of
Management Investigation and Dissertation MN6P00NI

information between the patients with the agency (GHI). The functionality of all this will
lead towards the satisfactions among the clients.
Management Investigation and Dissertation MN6P00NI

Research Title

Effectiveness of Government health insurance: A case of Pokhara Academic of Health Science

(Western Regional Hospital)

Chapter: Introduction
In our busy lives, there is always the possibility of uncertainty leading to catastrophic health
expenditure. There is always a chance that someone close to us might be at mercy of chronic
illnesses that need long-term care. Fortunately, there is health insurance as an important risk
management technique. Which ensures that undergoing long-term treatment does not put families
into a dire financial strait.
The contribution of health insurance to health financing is an increasing trend among emerging
and developing economies. Similarly, the Government of Nepal has made notable progress in
improving the overall health status of the population through the ‘Government health insurance
Scheme’ in the past decade. This research paper aims to know the effectiveness of ‘Government
health insurance’ among its policyholders. The study mainly emphasizes how effective is
government health insurance in terms of cost, availability of health care service, and risk coverage.

1.1) Background
The organized history of the Nepalese insurance industry was not a new phenomenon since, the
establishment of the first nonlife-insurance company “Nepal Transportation and Insurance
Company” in 1947. Whereas, the history of Health insurance is quite younger in Nepal, as it was
introduced by non-insurance organizations in the late 1970s, the Insurance company in the early
1990s, and the government of Nepal in the late 2010s. Where the first health insurance was
practiced by the United Mission to Nepal in name of the Lalitpur medical insurance Scheme in
1976. (Ghimire, 2018)
Lately, in 2000 ‘The BP Koirala Institute of Health Science’ in Dharan has started health insurance
that covered urban and rural populations, offering the same benefits package at a different premium
rate.

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For a few decades, many schemes offered by different commercial health insurance providers were
emerged and disappeared due to the small coverage, high cost, and low premium. Therefore, the
Government of Nepal launched a universal social health insurance program in 2016 under Social
Health Security Development Committee to provide health security coverage and ensure access,
utilization of quality health services at an affordable cost for all citizens of Nepal. it began as a
pilot program in three districts and later spread to 39 districts and is estimated to cover the entire
country by 2020. (Jha, 2018). Further in order to increase the awareness among the citizens of the
country, every kind of media have been used and effective advertisement
However, Government of Nepal Launched universal social health program only since, 2016 under
social Health Security Development (SHSDC) which was established to provide health security
coverage and ensure access to and utilization of quality health services at an affordable cost for all
Nepalese Citizens. The health insurance program was started from three district as a pilot program,
which then gradually spread out in 39 districts. And is estimated to

1.2) Statements of problems

In the realization of the importance of health insurance, the government of Nepal introduced a
universal social health insurance program. Thus, the government has invested a considerable
amount of money to ensure that government insurance programs operate efficiently and provide
quality services to its policyholders. Even though Government health insurance in its operation for
over half of the decade, the government has been steadfast in ensuring easy access to health
services. But very little is known regarding the performance of the Government health insurance
provider in extending health care service to its client. The policyholders still dealing with problems
about health care utilization, getting proper access to care as well as facing difficulties in claim
and reimbursement. This study, therefore, intended to examine the operation of government
insurance providers especially for the western regional hospital (Pokhara Academic of Health
Science) as it is promised, and whether it covered the risk and improved access to quality health
care service to the policyholders.

1.3) Research questions

Following are the research questions regarding this study.

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• What are the factors that directly influence the effectiveness of Government health
Insurance?
• How effective service does the western regional hospital provided to the GHI
members?
• What are the difficulties that GHI members and aligned hospitals were facing?

1.4) Research Objectives

Following are the objectives this study

• To identify the factors that influence the effectiveness of government health insurance
among policy holders
• To analyze the consumer’s experience and perception towards service rendered by the
Government health insurance Nepal.
• To examine the difficulties that GHI members and aligned hospitals are dealing with.

1.6) Significance of the study

• The study explores the operation of government health insurance providers. The findings
are expected to shed some light on whether they are performing as expected or not. this
will be useful for government bodies like the Health Insurance Board and the Ministry of
Health and Population.
• The study provides crucial information for government health insurance policyholders and
those who are thinking of buying in the future, as it examines the effectiveness of
Government health insurance for people of different ages and health categories of people.
• The research provides useful reading and reference material for future researchers in health
care services.
1.7) Organization of Study
This research paper is organized into five chapters. The first chapter or introductory chapter
discusses a social-economic aspect of the study area like introduction, background to the study,

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statement of the problems, objectives of the study, research questions, significance of the study,
and limitation of the study respectively. Similarly, the second chapter presents a literature review:
industry profile, theoretical review, empirical review, conceptual framework, operationalization
of variables, and Hypothesis. The third chapter discusses the research methodology. The fourth
chapter presents the data collected and discussed the findings. Finally, chapter five presents the
summary of the study, conclusion, and recommendation.

Chapter 2: Literature review

2.1) Theoretical review

Various frame work have been introduced to access quality of service delivered by western
regional hospital aligned with GHI. These models are critical in maintaining the so-called
effectiveness among customers in the health care industry. Below are the some of the health care
quality frame work.

2.1.1) Bamako Initiative

In 1987, the United Nations International Children's Emergency Fund (UNICEF) and WHO
developed the Bamako Initiative model in Bamako, Mali. The Bamako effort aims to protect the
poorest and ensure that prices do not prevent poor and marginalized communities from accessing
basic primary health care services. The model assesses health-care quality based on four quality-
care components: effectiveness, efficiency, sustainability, and equity. (Omololu, et al., 2012). As
per WHO (2007 b) effectiveness refers to services provided to overcome the most essential health
problems through preventive and curative health care service. Similarly, Sustainability represents
efforts made to ensure participatory financing of health care services, in which the community or
service customers are completely involved in the management and funding of health care services.
Equity refers to services that are provided to those who require them without discrimination for
their geographic, economic, or social background; it should allow for exemption and cost
subsidization.

2.1.2) Donabedian model

The Donabedian model is a conceptual model that provides a framework for investigating health
services and evaluating care quality. Donabedian developed the original model in 1966. According

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to the model information about the quality of care can be drawn through three different categories;
‘structure’, ‘process’ and ‘outcomes. (Berwick & Fox, 2016).

According to the model, structure include all the factors that affect the context in which health care
is delivered. In this research, structure includes physical facilities, equipment and human resource
as well as organizational characteristics such as staff training and payment method at aligned
hospital, which had a direct relation on effectiveness of GHI. These factor control how western
regional hospital and patients in a health care system act and are measure of the average quality of
health care facility. The structure was easily observed and measured in this study as it is cause of
problems identified in the process. (Crowe & Cresswell, 2011) (Berwick & Fox, 2016). Similarly,
the process is the sum of all actions that make up health care (Donabedian, 1988). Process in
effectiveness of GHI commonly includes: diagnosis, treatment, preventive care, and patient
education. According to Donabedian, the measurement process is nearly equivalent to the
measurement of quality of care because process contains all acts of health care delivery. Finally,
outcomes are considered as the effectiveness of GHI as it is the effect of health provided by GHI
to the patient. It is the most crucial indicators of effective health insurance as the improving patient
health status is the primary goal of GHI.

2.2) Concept of the effectiveness of GHI

Effective health insurance usually means insurance that is cheaper in terms of cost and provides a
variety of necessary medical facilities and covers the risk of policyholders. Similarly, the
effectiveness of Government health insurance means the insurance which ensures financial risk
protection access to quality essential health- care service and safe effective, and afforded essential
medicine and vaccine for all. (Ranabhat, et al., 2020).

2.3) Some Factors influencing the Effectiveness of GHI

2.3.1) Premium and Subsidies
In the research conducted by Mr. Shiva Raj Mishra and Team, they referred that the amount
you pay for your health insurance every month is known as the premium cost for your health
insurance. They also highlighted that in the government’s current health insurance policy, a family
of 5 members must pay 3500 Nepalese rupees per year to cover all types of health services with a
maximum limit of 100,000 rupees. If there are more than 5 members in the family, they need to

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pay 700 rupees per person. it also provides different subsidies for poor people and old age patients
like deduction on premium or no premium. They also mention that insurance with lower premium
costs and more subsidies would be effective and an important factor in the context of Nepal.
(Mishra, et al., 2015)

2.3.2) Risk Coverage

Andrew J Branes in his study says effective health insurance gives family members a feeling of
security. He also reveals that health insurance must cover the cost of any catastrophic medical
expenditure. Moreover, He concluded that effective health insurance somehow depends on the
amount of risk it covers. (Barnes & Hanoch, 2017) .

2.3.3) Availability of Health care service

A research article by Benedict Asibey & Seth Agyemang referred that the use of health care
services and equipment are essential. So, the effectiveness of health insurance also depends upon
the range and availability of health care services includes on it e.g. essential medicine, use of
modern equipment and laboratory facilities as required at the aligned, hospital, etc. (Asibey &
Agyemang, 2017)

2.4) Empirical Review

There is a large number of studies carried out on the effectiveness of Government health insurance
in India and western countries but there are only a few studies carried out in Nepal in this area.
Focusing on every aspect of the health insurance scheme is one of the most important factors while
making it more efficient for people. A study conducted in South Africa by Smith (2008) to
Determinants of the quality health insurance employing questionnaires and documentary review
has findings that despite the strong economic status of south Africa the quality of health insurance
scheme is still low.
Similarly, Abel and Lawal (1994) carried a study in Ghana on assessing the quality of health
insurance using a study design. the findings reveal that insurance members made greater use of
expansive hospitals: this is due to poor service provided by the government service provider. Thus,
the government health policy only was not effective in some cases. (Michubu, 2018).

Makonomalonja (2010) conducted a study in Mwanza on the perception of patients on the quality
of health care services in Government health care facilities: a case design study the findings shows

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that a higher proportion of respondents suggested that there are poor services in hospitals aligned
with government health insurance, the major cause being unavailability of modern equipment, low
number of qualified health workers, poor communication systems. (Munyogwa, et al., 2020)

Moreover, a study by Kedare (2012) focused that the respondents focused on hospital care the
most important feature of the insurance policy. Whereas they referred to income as the barrier to
health insurance purchase. This denotes that the effectiveness of health insurance is directly
affected by premium charges and subsidies. (Gopal, 2021)
2.5) Conceptual framework
This study aimed to analyze the effectiveness of Government health insurance in the case of
western regional hospital. this section presents a framework for assessment based on three
independent variables: Premium and Subsidies, Risk coverage, and Availability of health care
service. Whereas the framework has the Effectiveness of Government health insurance as
dependent variables. The figure below shows the relationship between the factors used to analyze
the effectiveness of government health insurance.

Premium And
Subsides

Effectiveness of ‘Government
Risk Coverage Health Insurance’ policy

Availability of health
care service

Figure 1: Conceptual framework

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2.6) Operationalization of the Conceptual framework

Objectives Variables Indicators Approach for analysis

a) To examine Premium a) Premium cost a) Observation from
the and b) Subsidies for people Insurance of National
effectiveness subsides from different categories health insurance
of Board.
government
health b) Observation from the
insurance website of the National
health insurance
Board.

Risk a) Security from a) Observation from

coverage catastrophic questionnaires
medical provided to
b) To analyze the expenditure respondents
consumers, b) Coverage for b) Observation from
experience, critical and questionnaires
perception towards surgical illness provided to
Health care services respondents
provided by

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Government Health Availability a)Availability of

insurance of Health essential c)Observation from the facility
Care medicines. together with questionnaire
service b)Availability of provided to the clients.
modern
equipment and
laboratory d)Observation from the facility
services in collaboration with an
interview with health care
providers.
Table 1: table to show operationalizations of the Conceptual framework

Chapter 3: Research Methodology

3.1) Research design
This research paper employed a case study design among four different research designs i.e.,
Longitudinal design, survey design, case study design, and experimental design. A case study is a
research method empirical investigation that explores current events about their real-life context,
especially when the boundaries between the phenomenon and context are not clearly or explicitly
defined. based on an investigation of a single individual, group, or event (Crowe & Cresswell,
2011). in this research, the selection of ‘case study’ design makes a possibility of capturing real-
life situations experienced by respondents. Further, this design enables investigation of
Government health insurance policy to be made in its operational context, especially in selected
hospital ‘western regional hospital’. it also enables the collection of original data regarding the
performance of the Government health insurance policy to address the research question.

3.2) Population of Study

The study is carried out in ‘Pokhara Academic of Health Science (Western Regional Hospital).
Where the study involves the inclusion of two categories of respondents i.e., government health

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insurance policyholders and providers at Western Regional Hospital. the criteria for the respondent
selection involves membership to the Government Health Insurance policy (principal Members,
dependent members, or retired members. Also, it involved respondents who used Government
health insurance services at least once and were willing to participate in the research. Services
providers were included in the study to access both the availability and quality of health care as
they have information concerning the Government health insurance service.

3.3) Sample Frame

The sampling frame is the list from which units are drawn for the sample (Yadava & Rai, 2019).
Similarly, list of all of the government hospital that provides the GHI service were the sample
frame for the study for choosing ‘Western regional hospital’ as the place to conduct research.
Further, only 125 respondents were chosen in the research from the sample frame which includes
the list of all GHI members across the country.
3.4) Sampling Techniques
The study covers the opinion and experience regarding the Government health insurance service
at Pokhara Academic and among the respondents. The data has been collected using a structured
nominal, ordinal, and ratio scale of measurement. The study employed purposive sampling
methods to select a few interview samples that involve the service providers of GHI at Pokhara
Academic of Health Science. whereas, Random sampling is used to select the respondent which
involves the policyholders of GHI. This process continued until 125 respondents were selected
among the policyholders who came to Gandaki regional hospital.

3.5) Data collection technique

the research employed both primary and secondary data in the course of gathering information.
These aspects are clarified below.

3.5.1) Primary data source

The term "primary sources of data" refers to firsthand data or information that ha been generated
by the researcher himself/herself, survey, interview, experiment, specially designed for
understanding and solving the research problems at hand (Crowe & Cresswell, 2011) (Rwin,
2021). Similarly, source for primary data in the study are research questionnaires and interviews

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and observation at western regional hospital. As indicated above a sample of health insurance
service providers at western regional hospital was interviewed to collect detailed information about
client experience with the ability of health care services and their assessment of quality health care
service. to do so 125 copies of questionnaires intended to capture opinion and experience of GHI
members. Where the first part of the questionnaires included questions regarding the demographic
profile of the respondents and second part ask the opinion and experience GHI members on scale
of 1-5 (as shown in questionnaires in appendix). further observation was used to access the
availability of health care service at western regional hospital. Aspect observed includes hospital
opening time, availability of doctors and nurses, handling of patients by the health care providers,
medical equipment and supply, availability of the resting rooms, sanitary situation, the mechanism
used to solve clients’ complaints as well as the presence of the inquiry desk and time the patients
had to spend waiting to see a doctor and receive medical attention.
3.5.2) Secondary data source
Secondary data are the data and information that have been recorded by other peoples (Crowe &
Cresswell, 2011). In the context of this study, it reviewed various authentic reports such as journal,
article leaflets, pamphlets, blogs as well as websites regarding GHI services as well as hospital
reports on western regional hospital performance aiming at cross checking the effectiveness of
GHI service. likewise, additional data were gathered from previous research on health care service.
all the resources were used to deliver relevant information on availability and quality of GHI
healthcare service at Western regional hospital.

3.6) Data Analysis Technique

In this study, data was collected from the Questionnaire and observation. Questionnaire data
were analyzed by using descriptive statistics, which where computer software called
Statistical Package for Social Science (SPSS) version 26 was used to summarize and
present data in relevant frequency and percentages tables, that facilitated the consumers
experience and satisfaction with healthcare service of western regional hospital as well as
GHI effectiveness. the analysis of quantitate data involves sorting, arranging and grouping
the data in term of their type (nominal, ordinal and scale). Whereas the analysis of

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qualitative data also involved the use of direct quotes from the respondents to capture
respondents word expression, felling and expectation with the hospital.

3.7) Reliability of the research

The term reliability of the study refers to how identical the result would be if another researcher
conducted the same research in another place and time (Middleton, 2022). Several techniques were
attempted in an attempt to satisfy the reliability standard. First an attempt was made to make the
whole course of research clear. It is the duty of the responsibility of the researcher to make in depth
clarifications on how the research was carried out. Which include the includes the clarification of
the study population, sample and data analysis.
Second, an effort was made to make sure research problems, objectives and research questions are
clear, because the research objectives and research question were the cornerstone of this entire
research. That means lack of certainty in these aspect of research leads to misunderstanding and
ineffective research. Furthermore, all recommended technique in the selection of the study sample,
data collection methods and analysis were observed. Similarly, the conceptual framework that
guided the study was carefully chosen based on the research goals and was actually applied in the
data analysis process. Fourth, the independent and dependent variables were relevant to the study,
and the indicators for the study variables' analysis were clarified and consistently used to guide the
analysis of the availability and quality of health care services at the case study hospitals.

3.8) Validity of the research

Validity referees to whether the methodologies employed in conducting research properly measure
what they were designed to assess. In other word it refers to how well the result among the study
participants represent true findings among similar individuals outside the study. (Patino & Ferreira,
2018). Similarly, several approaches were used to ensure the validity of the study finding. The
research has employed high quality and appropriate methods and measurement techniques.
Similarly, the research was targeted in accordance with the objectives and question, where research
questions was very straightforward so as to provide the best room for respondents to understand it
well and provide responses that matches the focus of the study. Therefore, the report ensure that
the conclusion reached are based on the research data, unlike researcher’s own bias.. Further to

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produce valid generalizable results the population were clearly defined which ensure that the
research had enough participants and that they are representative of the whole population

3.9) Ethical consideration

Different ethical considerations were used during this study which began with the taking
permission to conduct survey at with western regional hospital. this entitled presenting an
recommendation letter from the college to the hospital, asking management to grant the research
to carry out research. Before that an email was sent to college for writing a recommendation letter
with the approval of CEO. Further, the respondents were made aware that they were free to
participate or withdraw at any time during the interview. Similarly, they have the right to
understand the intention of the research and how the research findings will be utilized, and what
their involvement will entail. Lastly, respondents were grunted that their responses will be kept
confidential and only be used for academic purpose.

Chapter 4: Data Analysis and Discussion

4.1) Introduction
Data analysis is the process of evaluating data using analytical and logical reasoning to
examine each component of the data collected (Johnson, 2022). This form of analysis is
just one of the many steps that must be completed when conducting research. Data from
various sources are gathered, reviewed, and then analyzed to discussed their meaning and
draw conclusions (Calzon, 2022). Similarly, this chapter contains detailed presentation of data
gathered and discuss the findings from the research in line with research objectives. The research
findings are presented by categorizing them in line with the study objectives and questions. where,
Questionaries data were analyzed by using descriptive statistics, which where computer software
called ‘Statistical Social Science (SPSS) version 26 was used to summarize and present data in
relevant frequency and percentage table that facilitated the assessment of effectiveness of GHI.
Further, study was explored using the t-test, ANOVA, and correlation analysis to determine the
relationships between the variable.

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4.2) Demographic Characteristics of the respondents

The demographic profile of the respondents examined were Gender, age, education, monthly
income of the respondent’s family. further it includes income as well as basic awareness regarding
health insurance. these characteristics are essential because they suggest the nature of the
respondents’ responses or possible reasons for the responses provided by the respondents. These
characteristics were the essential as they suggested the nature of the respondents’ responses or
possible reasons for the responses provided by the respondents.

4.2.1) Distribution of respondent’s gender.

the purpose of collecting data on the basis of gender was to determine whether there was difference
in GHI membership difference between male and female. The findings show (table 2) almost 59%
respondents were male and approximately 36% are female. Whereas, there were nearly 6.4%
respondents other than male and female. This potentially suggest the finding of the study were
derived from both the male and female.

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Table 2: Table to show the gender of respondent.

Gender of the respondent

Cumulative
Frequency Percent Valid Percent Percent
Valid male 73 58.4 58.4 58.4
female 44 35.2 35.2 93.6
others 8 6.4 6.4 100.0
Total 125 100.0 100.0

Gender of Respondents

Male
6.4%
Female
35.2% Other
58.4%

Figure 2:Graph to show the gender of the respondents

The findings suggest that the gathered data in this research roughly represent opinion and
experience of every gender, while male being the majority.

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4.2.2) Categories of respondents by age

the age distribution of respondents was grouped into four categories; below 18 years, 18-30 years,
30-50 years, 50 and above. Where, approximately 38 percentage of respondents in this survey
reported being 50 years or older. Similarly, nearly 37 percentage of respondents were between
ages 30 and 50, nearly 17 percentage were between 18 and 30 years. furthermore, only 18
percentage of those polled were under the age of 18 year.

Table 3: table to show the age of the respondents

Age of the respondents

Cumulative
Frequency Percent Valid Percent Percent
Valid below 18 years 15 12.0 12.0 12.0
18-30 years 21 16.8 16.8 100.0
30-50 years 42 33.6 33.6 83.2
50years or above 47 37.6 37.6 49.6
Total 125 100.0 100.0

Age of the respondents

12%

below 18 years
37.6%
16.8% 18-30 years
30-50 years
50years or above
33.6%

Figure 3: Graph of the respondent’s age

The finding suggest that the respondents were old aged and middle aged likely to take health care
issue seriously and also in a position to make informed and independent assessment of the quality
of health care service under GHI.

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4.2.3) Education level of respondents

The education of the respondents was categories into four group. In involves those who had
reached high school, college degree, master degree and those who had no formal education. Well,
the respondents reported 37% having completed a higher school diploma, 30% having a college
degree, and just 15% possessing a master's degree. In addition, 12% of respondents had no formal
education while 6% chose not to declare their level of education.

Table 4: table to show the education level of the respondents

Education level of respondent

Cumulative
Frequency Percent Valid Percent Percent
Valid No formal education 17 13.6 13.6 13.6
Higher school diploma 40 32.0 32.0 45.6
College degree 40 32.0 32.0 77.6
Master degree 20 16.0 16.0 93.6
Prefer not to say 8 6.4 6.4 100.0
Total 125 100.0 100.0

Education level of the respondents

6%
13.6%

15% No formal education

Higher school diploma
College degree
30%
Master degree

32% Prefer not to say

Figure 4: Graph of the respondent’s education level

The findings suggest that the majority (62%) respondents were sufficiently educated and hence,
capable of expressing their experience and even analyzing GHI’s performance in relation to its
stated objectives,

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4.2.4) Monthly income of respondent’s family

Table 5: table to show the monthly income of respondent’s family

Monthly income of respondent’s family in Rupees

Cumulative
Frequency Percent Valid Percent Percent
Valid 0-10000 9 7.2 7.2 7.2
10000-30000 23 18.4 18.4 25.6
30000-50000 27 21.6 21.6 47.2
above 50000 29 23.2 23.2 70.4
prefer not to say 37 29.6 29.6 100.0
Total 125 100.0 100.0

Monthely income of the respondents

7.2%
0-10000
29.6% 18.4%
10000-30000
30000-50000
above 50000
21.6% prefer not to say
23.2 %

Figure 5: Graph of the monthly income of the respondents family.

As we can see in above table and figure, the majority of respondent’s family had the income level
above 30 and 50 thousand. Which suggest that the majority of respondents were willing to pay the
insurance premium.

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4.2.5) Work status of the respondents

The work status of the respondents was also categorized in four group; those who study, work as
a professional, had their own business and those who work for government.

Current work status of respondent

Cumulative
Frequency Percent Valid Percent Percent
Valid student 27 21.6 21.6 21.6
professional 26 20.8 20.8 42.4
business 23 18.4 18.4 60.8
Government servant 25 20.0 20.0 80.8
prefer not to say 24 19.2 19.2 100.0
Total 125 100.0 100.0

Work status of respondents

Students
19% 22%
professional
business
20% Government sevent
21%
Prefer not to say
18%

As seen in the demonstration above, the total portion of students among the respondents was 22
percentage. Similarly, there were 21 percentage respondent work as professional in various field,
20 present age work for the government, while there were only 18 percentage own their private
business. the majority of respondents suggest they adequately aware of GHI through their
professional life.

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4.2.6) Respondents’ awareness regarding health insurance

Respondents’ awareness regarding GHI

Cumulative
Frequency Percent Valid Percent Percent
Valid Yes 125 100.0 100.0 100.0
No 0 0.0 0.0 0.0

Respondents awareness regarding

GHI

0%

Yes
No

100%

Since, the research was conducted by targeting the policyholders of government health insurance,
all of the respondents stated they were aware of health insurance on some level. This can also be
seen in the above figure and graph, where the proportion of respondents who were aware of GHI
was 100, i.e., 125 respondents, while the percentage of individuals who had not heard of GHI was
0.

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4.2.7) Respondents means of awareness regarding

To identify the means via which respondents were aware about GHI five different options were
set i.e., website, friend/family, newsletter, advertisement. Where, the majority of respondents
(47.2%) had heard about GHI via friends and family. Similarly, 25.6 % of respondents
heard about GHI through advertisements, 15.2 % through websites, and 12 % through
newsletters.

Respondents means of awareness regarding GHI

Cumulative
Frequency Percent Valid Percent Percent
Valid website 19 15.2 15.2 15.2
Friends/family 59 47.2 47.2 62.4
Newsletter 15 12.0 12.0 74.4
Advertisements 32 25.6 25.6 100.0
Total 125 100.0 100.0

Respondesnts mean of awareness

regarding GHI

15.2%
25.6% Website
Friends/family
Newsletter
12%
47.2% Advertisements

The findings shows that the majority of GHI policy holders were influenced by their friend and
family.

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4.3) Descriptive statistics of variables

Descriptive statics are used to summarized data in an organized manner by describing the relations
between the variables in a sample. Calculating descriptive statistics is an important first step in
research and should always be done before performing inferential statistical comparisons.
(Bhandari, 2022). Well, in this research, the characteristics of a data set were summarized and
organized by using descriptive statistics. Where, a data set was a collected responses or
observations from a population or sample as a whole.

Table 6: table to show Descriptive statistics of variable

Descriptive Statistics
Minimu Maximu Std.
N m m Mean Deviation Skewness Kurtosis
Std. Std. Std.
Statistic Statistic Statistic Statistic Error Statistic Statistic Error Statistic Error
Premium_and_Subdies 125 3.00 15.00 8.1360 .25394 2.85777 .902 .217 .112 .430

Risk_Coverage 125 3.00 15.00 7.6720 .25561 2.83917 .674 .217 -.229 .430

Availavilty_of_healthca 125 3.00 37.00 9.3200 .31410 3.51173 4.028 .217 30.243 .430
re_service

Valid N (listwise) 125

Well, mean is the first statistics which was used for data analysis in this research. As shown in the
table, the ‘availability of healthcare service’ and ‘premium and subsides’ had the highest mean i.e.,
9.320 and 8.136, which shows that they were the most influencing factor for GHI being effective.
Similarly, Risk Coverage also have comparatively low mean indicating it was the least influencing
factor for GHI.

Similarly, standard deviation was also used for data analysis. It is the number used to indicate how
group’s reding are distributed over the mean or expected value. Where, the findings show
‘availability of healthcare service’ had higher standard deviation indicating its data (respondents’
responses) are highly spreader from its average mean. Whereas, ‘premium and subsides’ and ‘Risk
coverage’ had comparatively lower standard deviation

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4.4) Correlation analysis

Correlation is a measure of monotonic association between 2 variables where change in magnitude
of one variable is associated with a change in the magnitude of other variables, either in the same
or in opposite direction (Schober & Boer, 2022) . similarly, the correlation between three
independent variables were calculated in accordance with single dependent variable to measure
the strength of their relationship. The findings show the strong correlation between effectiveness
of GHI and availability of health care service was 0.874. similarly, correlation between variable
i.e., Effectiveness of GHI with ‘premium and subsides’ and ‘Risk Coverage’ were 0.842 and 0.777
respectively.

Table 7: table to show the correlation between variables

Correlations
Premium_and_S Availabilty_of_h Effectiveness_of
ubdies Risk_Coverage ealthcare_service _GHI
Premium_and_Subsides Pearson Correlation 1 .729** .407** .842**
Sig. (2-tailed) .000 .000 .000
N 125 125 125 125
Risk_Coverage Pearson Correlation .729** 1 .416** .777**
Sig. (2-tailed) .000 .000 .000
N 125 125 125 125
Availability_of_healthcare_ser Pearson Correlation .407** .416** 1 .874**
vice Sig. (2-tailed) .000 .000 .000
N 125 125 125 125
Effectiveness_of_GHI Pearson Correlation .842** .777** .847** 1
Sig. (2-tailed) .000 .000 .000
N 125 125 125 125
**. Correlation is significant at the 0.01 level (2-tailed).

The above findings suggest that the effectiveness of government health insurance is highly
dependent on availability of health care service as there was a strong correlation between them. It
means the positive changes in availability of healthcare service can highly influence effectiveness
of GHI among their members. Similarly, premiums and subsidies have had an impact on the degree
of effectiveness of GHI, as they also have a stronger correlation. whereas, the degree of risk
coverage had a slightly weaker correlation compared to other variables, suggesting that the

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effectiveness of GHI among members is not highly depended on the insurance scheme's level of
risk coverage.

4.5) Hypothesis

A hypothesis is a statement of the researcher's expectation or prediction regarding the relationship

between the variables in the study. The research process begins and end with the hypothesis. It is
a crucial to the entire procedure and, as such, is critical. The hypothesis is nothings but the heat of
the research. (Mccombes, 2019). Similarly, in this study different hypothesis were set,

i. Null hypothesis, H0 : μ ≥ 50 (premium charged by GHI is reasonable)

Alternative hypothesis, H1 : μ < 50 (premium charged by GHI is not
reasonable)

ii. Null hypothesis, H0 : μ ≥ 60(GHI cover the catastrophic medical

expenditure)
Alternative hypothesis, H1 : μ < 60 (GHI does not cover
iii. Null hypothesis, H0 : μ ≥ 50 (necessary health care services were available
at GHI aligned hospital)
Alternative hypothesis, H1 : μ < 50 (necessary health care services were not
not available at GHI aligned hospital)

one sample t-test was run to assess whether the null hypothesis can be accepted. not. Further
their test value was set by assuming the appropriate degree of responses required for null
hypothesis to be accepted. Where their significance was less than 0.005. (P< .001). hence, the
findings suggest to reject each null hypothesis.

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4.6) Discussion on each finding

This section presents the data collected and discusses the findings obtained from the case study
hospitals in an endeavor to address the two research objectives presented in the introductory
chapter. This analysis begins with the first research objective and proceeds to the second
objective.
The first objective of the study was to identify the factor that influence the effectiveness of GHI.
With respect to this research objective, the associated research question was, what are the factors
that directly influence the effectiveness of Government health Insurance? The examination was
done based on the conceptual framework in collaboration with the established indicators in the
second chapter. Where, ‘Premium and subsides’, ‘Risk coverage’ and ‘Availability of healthcare
service’ were the major factor influencing the effectiveness of GHI. Where, Availability of
healthcare service was found out as the most influencing factor for effectiveness of GHI.

Similarly in accordance with the research objectives intended to analyze the consumer’s
experience from the service provided by GHI as well as to examine the effectiveness of GHI among
its members to research question was derived i.e., How effective service does the western regional
hospital provided to the GHI members? and
Where the findings from western regional hospitals showed that clients together with the services
providers were not satisfied with the availability of health care services. Literature from instead
that customers satisfaction basing on the availability of accessible health care services. Therefore,
indeed the respondents from the field claimed that, they were not happy with the availability of
health care services under GHI. The study noted that, the major problem in all hospitals was the
issue of drugs. Respondents were asked if they accessed all drugs as prescribed by physicians.
Where the majority of respondents had an experience of collecting drugs from outside the hospital
pharmacies using forms filled at the hospital pharmacies and sometimes buying drugs outside the
hospital pharmacy. This proves that unavailability of drugs was the major issue that hospitals
confront. Meanwhile, the hospital's inability to provide pharmaceuticals (certain drugs could only
be given by doctors at the referral level), as well as lengthy procedures to get drugs and treatment,
remained an impediment to the hospital's ability to function properly.

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Further the issue of inadequate facilities is also a key challenge limiting the provision of health
care services to the GHI members. The findings revels, the hospital is facing problems of
inadequate supportive medical equipment’s like radiological (CT-scan, MRI, Ultrasound), modern
laboratory, lack of modern equipment’s at physiotherapy and occupational therapy as they have
not adequately invested in the creation of infrastructures capable of meeting the even increasing
demand for health care services. This leads all patients (GHI members and nonmembers) to share
the consultation rooms as the result, patients waited for so long to see the doctors. Observation
from the field showed that, patients had to spend an average of half and hours to be served only at
the registration counter. This was due to the fact that, the number of patients was hug enough
compared to the service providers. Patient have to dedicate their whole day in hospital for
treatment.
The hospital tried their level best at providing the demanded specialized services in the well-
arranged time table. Those time tables were pinned to the hospital’s notice boards to allow all
patients to have a look at the specific time as well as the day in which the particular service is
provided in the respective hospital.

Chapter 5: Conclusion and recommendation

5.1) Conclusion
Government health insurance is being rapidly scaled up across Nepal. However, without
appropriately designed incentives, including adequate monitoring and accountability systems,
these programs may not achieve its goals and benefit the target population. The study has given
valuable insight in identifying customers’ experience and perception of consumers towards
government health insurance. Based on data presented and analysis made, this research concluded
that; participants are more concerned about the Availability of health care serviced when it comes
to effective health insurance. instead of this GHI members were not getting adequate healthcare
service for example necessary drugs, necessary treatment equipment etc. from western regional
hospital which conclude GHI was not Soo effective to their policy holders.
meanwhile, the amount they paid for the insurance GHI premium has no significance impact on
the experience of GHI members as it is affordable.

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5.2) Recommendation
Relied on the research findings and the conclusion drawn above, the study recommends the
following:

5.2.1) Drugs and equipment availability

The government should ensure that pharmaceuticals are always available in hospitals at all time.
In addition, the method for procuring pharmaceuticals and equipment must be evaluated and
altered. If the government operate autonomously and receive subsidies only from government it
will be easy for hospital to maintain sufficient medicine at stock. Furthermore, the Government
must ensure that the regional hospitals possess equipment’s that will not only favor GHI
patient but also the public patient at large. This will reduce referrals to other private
hospitals.

5.2.2) Communication service and working environment

The research findings revealed that, the majority of the patients has never been involved in any
activity related to GHI by either service provider or GHI board herself. This study identified that
there was a gap between GHI service provider and beneficiaries. Communication between GHI
service provider and beneficiaries’ members occurred incidentally when patient had an issue to
confirm. The board should change on the way in which it should be communicating with its
beneficiaries. It is suggested that GHI board, in partnership with hospitals, build a system that links
directly information about served patients in all GHI aligned hospitals to the GHI database.
Hospitals should think about their employees' working environments as well as their patients'
waiting areas. GHI operational hospital will need to create a separate waiting room for GHI
patients, as well as offices for her employees.

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5.3) Limitation of the Study

Following are the limitation of the study:
• The research is based on primary data, where chosen respondents are limited and random.
• Lack of cooperation from the respondent, basically due to the time constraints.
because some of the respondents participated while being provided or receiving health care
service, thus the communication with respondents was somehow limited.
The researcher addressed this limitation by promoting cooperation from the respondents
by employing minimum time in the interview as well as in the filling up of questionnaires.

• The scheduling time exceeded the time frame, which had an impact on the overall budget
and strategy for the report. The researcher believed that data collection methods should
be completed within the time range provided. In order to solve such constraints,
researchers focused solely on the selected sample hospital.
• The research sample were chosen from sample frame. Thus, it may not represent the
overall research population across the country.
• The data was gathered with the respondents who were at the sample hospital at the time
of research. Therefore, the outcomes may varies as per change in respondents who were
not their at that time.

5.3) Future direction

• The researcher suggests going further and researching how GHI functions in rural regions
or districts where the majority of government workers reside, taking into account both
opportunities and limitations. Furthermore, they may rely on a big sample size since
the statistical significance of data may be revealed.
• The research recommended that future researchers focus on private health insurance or
compare all insurance schemes based on the benefits, relationship with the hospital, and
quality of their services.

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Appendix

Survey questionnaires
Survey Questionaries on ‘Effectiveness of Government Health Insurance’

Thank you for your participation in this survey regarding ‘Effectiveness of Government Health Insurance: A case of
Pokhara Academic of Health Science’. This survey is carried out for academic purposes with the intention of
identifying and investigating various factors that influence the effectiveness of Government Health insurance as well
as the quality of services they have provided. It will take approximately 5 minutes of times to complete this survey.
Furthermore, you are free to withdraw at any time during this survey without any hesitation. Additionally, I also
guarantee that all of your responses along with your identity will be kept totally confidential and used solely for
academic purposes.

There are two sections to this survey. Where the questionnaires under the first section are designed to understand
general information about your demographic profile. Similarly, the second section asks for your honest opinion and
experiences regarding the services provided by government health insurance which will be graded on a scale of 1-5.

What gender do you identify as?

1. Male
2. Female
3. Others
What is your age?
1. Below 18 years
2. 18-30 years
3. 30-50 years
4. 50 years or above
What is the highest level of education?
1. No Formal education
2. High School diploma
3. College degree
4. Master’s Degree
5. above
6. Prefer not to say
Which of the following best describes the monthly income of your family?
1. 0-10000
2. 10000-30000
3. 30000-50000
4. 50000-Above
5. Prefer not to say
What is your current work status?
1. Student

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2. professional
3. Business
4. Government Servant
5. Students
6. Prefer not to say
Have you heard about the health insurance schema?
1. Yes
2. No
3. Maybe

If yes, where did you hear about this?

1. Website
2. Friend/family
3. Newsletter
4. Advertisement
5. Other

Please rate the following statement on a scale of 1-5 (1=Strongly agree, 2=Agree, 3=Neutral,
4=Disagree, 5=Strongly disagree)
Variable 1: Premium and Subsides 1 2 3 4 5
The premium charged by Government health insurance companies is Reasonable.
The additional amount of premium charged for a family that has more than 5
members is reasonable.
Government health insurance provides a sufficient percentage of subsidy for ultra-
poor families, disability patients, and the elderly population.

Variable 2: Risk Coverage 1 2 3 4 5

Government health insurance can provide a sense of security regarding medical
care for family members.
Government health insurance can cover the out-of-pocket cost of catastrophic
medical expenditures.
Critical and surgical illness cover policies under Government health insurance
are favorable.

Variable 3: Availability of health care service 1 2 3 4 5

Pharmacy under Government health insurance aligned hospital provides essential
medicines to policyholders.
The hospital under the Government health insurance policy provides modern
equipment for treatments.

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Hospital under Government health insurance allows essential laboratory services

for patient.

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Gantt Chart

Week Week Week Week Week Week Week Week Week Week week Week
Work 1 2 4 5 6 7 8 9 10 11 12 13
Introduction
and background
of the Topic
Findings
Research
problems,
research question
and research
objectives

Organization
of the study

Literature
Review

Design
Questionnaire &
Survey
population

Data collection
from survey
population
Data analysis,
Interpretation
and findings
Discussion on
each finding
Conclusion and
recommendation
Appendix

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Proposed budget
Items Cost in Rupees
Stationeries, ink and cartridges 2000
Printing, Photocopy and binding 3000
Consumable materials 3000
Transport cost 3000
Total 11000

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Reliability and validity testing output

Case Processing Summary
N %
Cases Valid 125 100.0
Excluded 0 .0
Total 125 100.0
a. Listwise deletion based on all variables in the procedure.

Reliability Statistics

Cronbach's Alpha N of Items

.746 3

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SPSS Output
Descriptive statistics and correlation

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Frequency table for demographic profile

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One sample T-Test

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Recommendation letter

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Management Investigation and Dissertation MN6P00NI

Supervisor meeting Document

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Management Investigation and Dissertation MN6P00NI

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Management Investigation and Dissertation MN6P00NI

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Management Investigation and Dissertation MN6P00NI

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