Association of information, education, and communication with enrolment in health insurance: a case of Nepal

Abstract

Background Many studies indicate that various health programmes have been failed because of the lack of appropriate information, education, and communication [IEC] for the target audiences. It is still unanswered which methods/means of communication could be the most powerful for changing behaviour or decision-making capacity. The paper aims to assess the effects of IEC on family enrolment in health insurance programme [HIP] in Nepal. Methods We employed a household-based observational study with a control group. Altogether 810 household interviews were conducted in Baglung and Kailali districts of Nepal in 2018. The study used a validated structured interview schedule. Background characteristics of the family and respondents and their exposure to the means of communication were the independent variables while enrolment in health insurance [HI] was the dependent variable. Results Data showed that 72% of the respondents heard about the HI and 66% knew the contribution amount for enrolment in HI. In the total enrolled households, 53% were household heads, 59% belonged to the age group 41–60 and 68% were above 60 years. More than half (56%) of rich compared to 46 and 49% of middle and poor (p < 0.05); 60% of the family member suffering from the chronic disease were enrolled in the HI. Similarly, 68% of those who heard about HI compared to 4 % who did not hear were enrolled (p < 0.001). A vast majority (69%) of those knowing contribution amount, 73% who interact with peer neighbour compared to 39% who did not, and 62% of those who listened to the radio and 63% of those who watched TV were enrolled in HI (p < 0.001). However, heard about HI (aOR = 21.18, 95%CI: 10.17–44.13, p < 0.001), knowledge about contribution amount (aOR = 5.13, 95%CI: 3.09–8.52, p < 0.001), having HI related books or guidelines (aOR = 4.84, 95%CI: 2.61–8.98, p < 0.001), and interact with peer or neighbours (aOR = 1.74, 95%CI: 1.34–2.65, p < 0.01) were appeared to be positive and significant predictors for enrolment in HI. Conclusion Knowledge about HI and interaction with peers and neighbours about the HI scheme of the government could lead to higher participation in the HIP. It would be better to incorporate this strategy while planning interventions for increasing enrolment in the HIP.

Predictors of health insurance enrolment and wealth-related inequality in Nepal: evidence from Multiple Indicator Cluster Survey (MICS) 2019

“…This finding is similar to the observation made by previous study conducted in Baglung and Kailali districts of Nepal that reported a significant difference in terms of health insurance enrolment between groups based on access to health insurance messages through radio and TV. 45 This association may be due to the fact that households with members exposed to mass media have better access to the information regarding the enrolment process and future benefits the membership offers in terms of financial risk protection. 45 In Nepal, Brahmin, Chhetri, Madhesi, Janajati and Newar are considered upper and privileged caste in comparison Dalits and other ethnic minorities.…”

“…45 This association may be due to the fact that households with members exposed to mass media have better access to the information regarding the enrolment process and future benefits the membership offers in terms of financial risk protection. 45 In Nepal, Brahmin, Chhetri, Madhesi, Janajati and Newar are considered upper and privileged caste in comparison Dalits and other ethnic minorities. Hindu and households from advantaged ethnic group were more likely to be registered with the health insurance schemes compared with non-Hindus and Dalits (including Muslims and ethnic minorities).…”

The association between media exposure and enrollment in health insurance in Nepal: Implications for health policy

“…Health Insurance Act (HIA), which was enacted in 2017. According to the HIA, there is a mandatory provision that every citizen needs to enroll in the HIP, however, the act has not been fully operationalized (Acharya et al, 2020). Some private banking and financial institutions have been luring customers with the promise of providing different medical support schemes.…”

Public Service Announcements for Health Insurance in Nepal: Perspectives from Health Belief Model

“…It may be the cause of inadequate knowledge and low satisfaction from HI programme and its functioning mechanism. Various factors associated with HI (Acharya, 2020); however, interaction with peers and neighbours appeared to influence enrollment (Acharya et al, 2020).…”