Adhikari Nilaramba, Wagle Rajendra Raj, Adhikari Dilli Raman, Thapa Puspa, Adhikari Muna
Save the Children International, Sinamangal, Kathmandu, Nepal.
Karnali Academy of Health Sciences, Jumla, Nepal.
J Nepal Health Res Counc. 2019 Jan 28;16(41):378-384.
Low income countries face considerable challenges in financing health care for their populations. As its consequences, poor people don't have access to desired health services, drugs and medicine.To address the financial barriers to health services, Government of Nepal introduced Community Based Health Insurance scheme at selected health facilities. However, enrolment in the schemeis very low. This study aims to identify the associated factors affecting enrolment in the insurance scheme.
A community based case-control study was conducted within the coverage area of CBHI scheme of Chandranigahapur Hospital. CBHI Scheme of Chandranigahapur Hospital was selected purposively. Altogether 416 households were interviewed using a structured questionnaire. The required number of sample size from the enrolled households as cases and equal number of non-enrolled households as controls were selected randomly in 1:1 ratio.
The odds of enrolment in the CBHI scheme among male-headed households were found lower than female-headed households (AOR 0.251, 95% CI 0.097 to 0.652). Similarly household head belonging to upper caste/ethnic groups (AOR 3.981, 95% CI 2.027 to 7.816) as well aseducated household head(AOR 6.184, 95% CI 3.137 to 12.188)were more likely to enrol in the CBHI scheme. Households having >60 years elderly were found significantly associated with enrolment in CBHI scheme(AOR 3.996, 95% CI 2.130 to 7.497). Time to reach health facility as well as affordability of premium of the insurance scheme was also found significantly associated with enrolment in the CBHI scheme.
The enrolment in the CBHI scheme is determined by combination of householdhead, household and health service related factors.These determinants should be addressed to enhance the enrolment in the insurance scheme.
低收入国家在为其民众提供医疗保健资金方面面临巨大挑战。因此，贫困人口无法获得所需的医疗服务、药品。为解决医疗服务的资金障碍，尼泊尔政府在部分医疗机构推出了基于社区的医疗保险计划。然而，该计划的参保率非常低。本研究旨在确定影响该保险计划参保率的相关因素。
在钱德拉尼加哈布尔医院社区医疗保险计划覆盖区域内开展了一项基于社区的病例对照研究。钱德拉尼加哈布尔医院的社区医疗保险计划是有目的地选取的。共使用结构化问卷对416户家庭进行了访谈。从参保家庭中按病例选取所需样本量，并以1:1的比例随机选取相同数量的未参保家庭作为对照。
发现男性户主家庭参加社区医疗保险计划的几率低于女性户主家庭（调整后比值比为0.251，95%置信区间为0.097至0.652）。同样，属于高种姓/族群的户主（调整后比值比为3.981，95%置信区间为2.027至7.816）以及受过教育的户主（调整后比值比为6.184，95%置信区间为3.137至12.188）更有可能参加社区医疗保险计划。发现家中有60岁以上老人的家庭与参加社区医疗保险计划显著相关（调整后比值比为3.996，95%置信区间为2.130至7.497）。到达医疗机构的时间以及保险计划保费的可承受性也与参加社区医疗保险计划显著相关。
社区医疗保险计划的参保率由户主、家庭和医疗服务相关因素共同决定。应解决这些决定因素以提高保险计划的参保率。
