Table 6.

Summary findings from service providers (qualitative).

SN	Theme/Pattern	Summary (intellectual translation)
1	Coverage of SHIP	Service providers and managers reported that there was almost 60–80% coverage of SHIP among the population in Illam, Baglung, and Kailali. Insurance agents of the respective wards in different districts facilitated the beneficiaries for SHIP enrollment. However, their limited mobility in the community had made a steady increment in SHIP coverage. Although there was incremental acceptance of SHIP was observed in the initial days, the declining trend was observed in subsequent years due to the limited availability of medicines and services under SHIP. It was noted that almost all people with chronic diseases have made health insurance.
2	Perceived premium and benefit package	The existing premium was perceived to be appropriate and affordable. Coverage of the service has been improving; however, the availability of limited services sometimes makes questionable about the premium. Services under SHIP were perceived as cost-effective and mostly used by insured people. Insured people who had hypertension mostly utilized the services of SHIP. Community acceptance was improved with 80–90% of people being satisfied with SHIP. Nevertheless, community acceptance of SHIP in Kailali was low because of the lower level of awareness among the population. The referral center was limited to a few hospitals only. There were problems in accessing and purchasing the equipment and medicines. Patients referred to higher centers have to be in the queue for care in higher health care institutions because of this, some insured people also discontinued. The annual renewal system of SHIP was not perceived to be user-friendly due to which there was poor adherence and a high proportion of drop out.
3	Providers' perception of beneficiaries' behavior	There was an affirmative perception of the insured and uninsured people regarding SHIP. Insured people have good availability and coverage of care. Insured people perceived that the services must be made available even from private institutions. Beneficiaries become disappointed when the uninsured got limited services to those insured beneficiaries and they feel irritated waiting in a queue to receive services. In addition, sometimes it is difficult to avail of services in time, and the referral system is also felt hectic.
4	Problems faced by insured and uninsured beneficiaries availing services	Limited availability of services from SHIP-implemented health institutions, long waiting times for their checkup/health care, and perception of difficulty in dealing with a hectic referral system. In the meantime, there were no verbal complaints as well as written feedback from the public and beneficiaries in regard to the problems faced.
5	Providers' perception of underprivileged	Effective delivery of services at all times, waiving the premium and renewal amount for insurance, making the SHIP compulsory for people with low SES, and providing awareness at the household level through mass campaigns or frequent visits made by the insurance agents may be useful to make insurance coverage of the underprivileged population.
6	Problems faced by service providers	Limited human resources, service packages, and financial resources regarding patients' expectations, nagging from the public, delayed reimbursement of expenditures made, and dealing with the rude behaviors of some people at the time-of-service delivery were the major problems encountered by service managers and providers in the study districts.
7	Occupational risk experienced by HCPs	The unavailability of the PPEs was experienced as an occupational risk among the SHIP providers and they also added that some patients' behaviors put them at occupational risk.
8	Facilitative factors of the SHIP program	Regular monitoring of the program, regular supply of services and medicines, good inventory management, monthly progress reporting, review meetings, and distribution of responsibilities among the staff facilitated the management of SHIP.
9	Ways to reduce the barriers (by HCPs)	Timely reimbursement of expenditures made for health care, promoting service provider-community bonding, use of technology and Apps, and mobilizing the trained human resources are useful to strengthen SHIP.
10	Measures to improve coverage, accessibility, and implementations modalities of SHIP	Mobilization of insurance agents, publicizing the program highlights among beneficiaries through different individual, group, and mass methods, expansion of services to both the public and private institutions, and development the effective referral mechanisms gradually improve the coverage of services and effective implementations of SHIP.