Nepal’s path to achieving universal health coverage by 2030 is currently faltering as its government-funded health insurance program contends with low enrollment and significant dropout rates. Despite governmental efforts, the program’s success is hindered by various factors that influence the population’s engagement. This study, utilizing data from the Nepal Demographic and Health Survey 2022, unveils the complex dynamics affecting health insurance enrollment in Nepal.
Geographical Disparities and Enrollment Rates
A comprehensive cross-sectional analysis of 14,280 households, including interviews with 14,845 women and 4,913 men aged 15-49, highlights stark geographic disparities in health insurance coverage. Koshi Province emerges as a leader with coverage reaching 21.8% in men and 20.4% in women, while Madhesh Province reports alarmingly low figures of 3.1% for men and 2.7% for women. These figures illustrate the uneven access to insurance across the country.
Socioeconomic Influences on Enrollment
The study further identifies a correlation between higher socioeconomic status, urban residence, and increased likelihood of enrollment in health insurance. Employment status also plays a significant role, yet no subgroup achieves more than 30% coverage. This disparity underscores the need for tailored strategies to enhance market access to the insurance program, especially for the economically disadvantaged groups.
Additionally, the research finds that individuals with higher education and wealth are more inclined to participate in the health insurance program. This trend is consistent across genders, highlighting the necessity for policies that address educational and economic barriers to increase enrollment.
Key Insights and Implications
The analysis reveals that:
- Urban areas show higher insurance coverage compared to rural regions.
- Employment status is a crucial determinant of insurance enrollment.
- Higher education levels significantly boost the likelihood of enrollment.
- Despite these factors, no subgroup surpasses 30% coverage, indicating systemic issues.
The findings indicate a positive relationship between health insurance enrollment and healthcare utilization. Insured individuals are more prone to seek medical services and report fewer access-related challenges, suggesting the potential for improved health outcomes if enrollment rates increase.
Efforts to reach the target of 60% coverage by 2023/24 are evidently insufficient at present, necessitating urgent policy interventions. Focusing on low-coverage regions and vulnerable populations should be prioritized to improve market access and bolster the program’s reach.
Original Article: PLoS One. 2024 Oct 3;19(10):e0310324. doi: 10.1371/journal.pone.0310324. eCollection 2024.
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