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

Prabesh Ghimire,Amod Kumar Poudyal,Vishnu Prasad Sapkota

doi:10.15171/ijhpm.2019.54

Prabesh Ghimire, Amod Kumar Poudyal + Show 1 more

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https://doi.org/10.15171/ijhpm.2019.54

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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.

Highlights

In many developing countries, out-of-pocket health expenditure of patients or their families constitute a large proportion of amount spent on healthcare
The evidence base for health insurance programs in Nepal remains very weak. It is against this background that the study aimed to identify the factors associated with enrolment of households in the Nepal’s National Health Insurance Program (NHIP)
Our study results showed that belonging to privileged ethnic group, having a higher socio-economic status, having an experience of acute illness by family member and presence of chronic illness in the family are the potential factors that influence the enrolment of households in NHIP

Summary

Introduction

Out-of-pocket health expenditure of patients or their families constitute a large proportion of amount spent on healthcare This proportion has been estimated to be the highest ie, 40.8% in the World Health Organization (WHO) South East Asia Region.[1] In Nepal, household out-of-pocket health expenditure alone contributes to 56.3% of current health expenditure.[2] In countries where out-of-pocket expenditure is the most important source of healthcare financing, households can experience financial catastrophe and often impoverishment as a result of their out-of-pocket spending on healthcare.[1,3] Over the past decades, many low- and middle-income countries (LMICs) have faced severe challenges to sustain sufficient financing for healthcare and to provide adequate financial protection against impoverishing effects of catastrophic illness.[4] Because of these concerns, moving away from out-of-pocket healthcare payments to prepayment social health protection mechanisms has widely been argued as an important step towards reducing risks from financial hardship. Various countries in the world responded to these calls by adopting different health financing mechanisms including voluntary communitybased and social health insurance schemes.[7]

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