Health Service Utilization and Out-Of-Pocket Health Expenditure Among Insured and Uninsured: A Comparative Study in Baglung District, Nepal

Abstract

Background Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias.Method A community based cross-sectional comparative study was conducted in Baglung district of Nepal to find out and compare the health service utilization and direct out-of-pocket health care expenditure among the 225 insured and 225 uninsured households under the national health insurance program of Nepal. Insured households were randomly chosen from study area and uninsured households were selected by using neighborhood method.Result The study focused that insurance status was strongly associated with heath service utilization with odds ratio 1.774 (95% CI = 1.127-2.791, P = 0.013). The study also depicts that insurance status was major determinants of out of pocket health expenditure. The median out-of-pocket health expenditure among insured households Nepalese Rupees 200 while among uninsured was 1225, which was statistically significant (p = <0.001 MW-U test). Among uninsured group, non-dalit were 2.846 times more likely to utilize health services compared to the dalit (p = 0.003) but it was not significant (p = 0.47) among insured group.Conclusion Nepal’s Health Insurance Board is responsible for purchasing the quality health care service and make available at possible nearest point of its member. Our study reveals that Occupation, perceived health status, wealth status played significant role with health service utilization among uninsured group while it was not significant among insured group. Among both insured and uninsured group none of the study variables were found significant with out-of-pocket health expenditure.