User satisfaction with the National Health Insurance Program: A community-based survey from the Ilam district of Nepal

Background: The Government of Nepal initiated a family-based National Health Insurance Program (NHIP) in April 2016, aiming to ensure universal health coverage (UHC) by enhancing access to and utilization of quality health services. However, NHIP, in its initial years of implementation, encountered challenges such as low population coverage, a high dropout rate, and concerns among the insured regarding the quality of healthcare services. There is a dearth of information regarding user satisfaction with the NHIP in Nepal. This study aimed to assess user satisfaction with NHIP at the household level in Nepal. Methods: We conducted a cross-sectional study among 347 households in the Ilam district using a multi-stage random sampling method. Face-to-face interviews were conducted with household heads enrolled in NHIP. A semi-structured questionnaire was used to collect the data. The multivariable logistic regression analysis was done to identify the predictors of satisfaction level. Results: Overall, 53.6% of the insured were satisfied with the NHIP, while 31.1% had comprehensive knowledge about the NHIP. Factors such as gender (AOR: 1.80, 95% CI: 1.08–3.00), distance to the first point of contact (AOR: 2.15, 95% CI: 1.24–3.74), waiting time (AOR: 2.02, 95% CI: 1.20–3.42), availability of diagnostic services (AOR: 1.90, 95% CI: 1.05–3.45), availability of prescribed medicine (AOR: 3.90, 95% CI: 1.97–7.69), perceived service quality (AOR: 2.20, 95% CI: 1.15–4.20), and the behavior of service providers (AOR: 3.48, 95% CI: 1.04–11.63) were significantly associated with user satisfaction. Conclusion: The satisfaction level among NHIP users was deemed moderate. This study highlighted several factors, such as gender, distance to the first point of contact, waiting time, availability of diagnostic services and prescribed medicine, perceived service quality, and the behavior of service providers, as key determinants impacting user satisfaction. Recognizing the pivotal role of user satisfaction, health insurance stakeholders must prioritize it to ensure higher retention rates and coverage within NHIP.