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Enrollment and associated factors of the national health insurance program of Nepal: Further analysis of the Nepal Demographic and Health Survey 2022

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  • Devaraj Acharya
  • Sushil Sharma
  • Kristin Bietsch

Abstract

The focus of this study was on the current enrollment status of the government-funded health insurance (HI) program in Nepal, which is necessary to achieve universal health coverage by 2030. Despite the government’s commitment, the program faces challenges of low enrollment and high dropout rates, hindering progress towards this goal. With a purpose to find out the associated factors for enrollment in HI, the cross-sectional study employs secondary data obtained from the Nepal Demographic and Health Survey 2022. A multi-stage sampling method yielded a representative sample of 14,280 households, and an interview was conducted with 14,845 females and 4,913 males aged 15–49. A weighted sample was employed and subsequently analyzed through the use of R. The analysis reveals a concerningly low enrollment rate, with only 10% of the surveyed population possessing government HI. Furthermore, significant geographical disparities were found to exist—Koshi Province had the highest coverage (21.8% men and 20.4% women), while Madhesh Province lagging far behind (3.1% men and 2.7% women). Additionally, the enrollment rates correlated positively with urban residence, higher socioeconomic statuses, and employment, with no subgroup surpassing 30% coverage, though. The study demonstrates a positive association between HI and healthcare utilization, with insured individuals exhibiting a higher likelihood of visiting health facilities and reporting fewer access-related issues. Respondents with higher levels of education and greater wealth were significantly more likely to enroll in HI than those with basic education and middle-level wealth, respectively. This pattern holds consistently for both males and females. These findings suggest that the program, aiming for 60% coverage by 2023/24, is currently off-track. Policymakers should interpret these data as a call for action, prompting the development and implementation of the targeted interventions to address enrollment disparities across Nepal. By focusing on the low-coverage areas and the vulnerable populations, the program can be strengthened and contribute meaningfully to achieving universal health coverage by 2030.

Suggested Citation

  • Devaraj Acharya & Sushil Sharma & Kristin Bietsch, 2024. "Enrollment and associated factors of the national health insurance program of Nepal: Further analysis of the Nepal Demographic and Health Survey 2022," PLOS ONE, Public Library of Science, vol. 19(10), pages 1-17, October.
  • Handle: RePEc:plo:pone00:0310324
    DOI: 10.1371/journal.pone.0310324
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    References listed on IDEAS

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    1. Sushmita Ghimire & Sailaja Ghimire & Devendra Raj Singh & Reshu Agrawal Sagtani & Sudarshan Paudel, 2024. "Factors influencing the utilisation of National health insurance program in urban areas of Nepal: Insights from qualitative study," PLOS Global Public Health, Public Library of Science, vol. 4(7), pages 1-20, July.
    2. Kwame Adjei-Mantey & Charles Yuji Horioka, 2023. "Determinants of health insurance enrollment and health expenditure in Ghana: an empirical analysis," Review of Economics of the Household, Springer, vol. 21(4), pages 1269-1288, December.
    3. Devaraj Acharya & Bhimsen Devkota & Gary L. Kreps, 2022. "Does perceived susceptibility and severity of health problems serve as drivers for household enrolment in health insurance? A case study from Nepal," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(2), pages 839-853, March.
    4. Devaraj Acharya & Bhimsen Devkota & Bishnu Prasad Wagle, 2019. "Factors Associated to the Enrollment in Health Insurance: An Experience from Selected Districts of Nepal," Asian Social Science, Canadian Center of Science and Education, vol. 15(2), pages 1-90, February.
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