Factors Associated with Enrolment of Households in Nepal’s National Health Insurance Program

Abstract

Background: Nepal has made remarkable efforts towards social health protection over the past several years. In 2016, the Government of Nepal introduced a National Health Insurance Program (NHIP) with an aim to ensure equitable and universal access to healthcare by all Nepalese citizens. Following the first year of operation, the scheme has covered 5 percent of its target population. There are wider concerns regarding the capacity of NHIP to achieve adequate population coverage and remain viable. In this context, this study aimed to identify the factors associated with enrolment of households in the NHIP.Methods: A cross-sectional household survey using face to face interview was carried out in 2 Palikas (municipalities) of Ilam district. 570 households were studied by recruiting equal number of NHIP enrolled and non-enrolled households. We used Pearson’s chi-square test and binary logistic regression to identify the factors associated with household’s enrolment in NHIP. All statistical analyses were performed using IBM SPSS version 23 software.Results: Enrolment of households in NHIP was found to be associated with ethnicity, socio-economic status, past experience of acute illness in family and presence of chronic illness. The households that belonged to higher socio-economic status were about 4 times more likely to enrol in the scheme. It was also observed that households from privileged ethnic groups such as Brahmin, Chhetri, Gurung, and Newar were 1.7 times more likely to enrol in NHIP compared to those from underprivileged ethnic groups such as janajatis (indigenous people) and dalits (the oppressed). The households with illness experience in 3 months preceding the survey were about 1.5 times more likely to enrol in NHIP compared to households that did not have such experience. Similarly, households in which at least one of the members was chronically ill were 1.8 times more likely to enrol compared to households with no chronic illness.Conclusion: Belonging to the privileged ethnic group, having a higher socio-economic status, experiencing an acute illness and presence of chronically ill member in the family are the factors associated with enrolment of households in NHIP. This study revealed gaps in enrolment between rich-poor households and privileged-underprivileged ethnic groups. Extension of health insurance coverage to poor and marginalized households is therefore needed to increase equity and accelerate the pace towards achieving universal health coverage.

Factors Associated with Non-Enrollment in National Health Insurance Scheme in Kaski District, Nepal

“…Other reasons might be elderly population wants future health security in their life and Government of Nepal is also protecting elder population by subsidizing the premium of geriatric population aged above 70 years. Existing literatures of Nepal and Ghana are similar with the present study (Adhikari et al, 2019;Badu et al, 2018;Jehu-Appiah et al, 2011) however another literature of the Nepal showed the contradictory result (Ghimire et al, 2019).…”

“…Facts from various studies have shown the positive association between socio-economic status and non-enrollment (Ghimire et al, 2019;Jehu-Appiah et al, 2011;Mirach et al, 2019;Paudel, 2019). The present study also showed that non-enrollment increases with the decreasing socio-economic status in the society.…”

“…This could be due to the geographical setting and population characteristics. Nevertheless findings from other studies say that underprivileged ethnic group has higher non-enrollment (Adhikari et al, 2019;Ghimire et al, 2019). Likewise, present study found religion has no association with non-enrollment.…”

Knowledge and Practice on Ecopharmacovigilance and Medicine Storage Amongst Medical and Dental Students in Lalitpur, Nepal

“…In Nepal, the concept of health insurance is at a preliminary stage and in the year 2016, the government introduced a national health insurance program which covered just 5% of the population 22 and hence consumers pay out-of-pocket to purchase medicines. Being a country with poor socioeconomic status any wastage of medicines can negatively impact healthcare affordability.…”

Status and determinants of enrollment and dropout of health insurance in Nepal: an explorative study

“…On demand side, socio demographic factors like education, economic status, access to health care facilities etc. are seen responsible for health care utilization in health insurance, but these studies are in small scale [28][29][30][31]. A study conducted by Nepal Health Research Council (NHRC) suggests that insured > 90% want to renew the health insurance scheme if it increases the coverage of the service package.…”