Public Health and Social Protection Professional, Kathmandu, Nepal.
Department of Economics, Nepal Commerce Campus, Tribhuvan University, Kathmandu, Nepal
BMJ Open. 2021 Nov 26;11(11):e050922. doi: 10.1136/bmjopen-2021-050922.
We analysed predictors of health insurance enrolment in Nepal, measured wealth-related inequality and decomposed inequality into its contributing factors.
Cross-sectional study.
We used nationally representative data based on Nepal Multiple Indicator Cluster Survey 2019. Out of 10 958 households included in this study, 6.95% households were enroled in at least one health insurance scheme.
measures health insurance (of any type) enrolment.
Households were more likely to have health insurance membership when household head have higher secondary education or above compared with households without formal education (adjusted OR 1.87; 95% CI: 1.32 to 2.64)). Households with mass media exposure were nearly three times more likely to get enroled into the schemes compared with their counterparts (adjusted OR 2.96; 95% CI 2.03 to 4.31). Hindus had greater odds of being enroled (adjusted OR 1.82; 95% CI 1.20 to 2.77) compared with non-Hindus. Dalits were less likely to get enroled compared with Brahmin, Chhetri and Madhesi (adjusted OR 0.66; 95% CI 0.47 to 0.94). Households from province 2, Bagmati and Sudurpaschim were less likely to have membership compared with households from province 1. Households from Richer and Richest wealth quintiles were more than two times more likely to have health insurance membership compared with households from the poorest wealth quintile. A positive concentration index 0.25 (95% CI 0.21 to 0.30; p<0.001) indicated disproportionately higher health insurance enrolment among wealthy households.
Education of household head, exposure to mass media, religious and ethnic background, geographical location (province) and wealth status were key predictors of health insurance enrolment in Nepal. There was a significant wealth-related inequality in health insurance affiliation. The study recommends regular monitoring of inequality in health insurance enrolment across demographic and socioeconomic groups to ensure progress towards Universal Health Coverage.
我们分析了尼泊尔医疗保险参保的预测因素，衡量了与财富相关的不平等，并将不平等分解为其促成因素。
横断面研究。
我们使用了基于尼泊尔 2019 年多指标类集调查的全国代表性数据。在纳入本研究的 10958 户家庭中，6.95%的家庭参加了至少一种医疗保险计划。
衡量任何类型的医疗保险（健康保险）参保情况。
与没有正规教育的家庭相比，户主接受过高中或以上教育的家庭更有可能参加医疗保险（调整后的优势比 1.87；95%可信区间：1.32 至 2.64））。接触大众媒体的家庭参加该计划的可能性几乎是其对应家庭的三倍（调整后的优势比 2.96；95%可信区间 2.03 至 4.31）。与非印度教徒相比，印度教徒参保的可能性更大（调整后的优势比 1.82；95%可信区间 1.20 至 2.77）。与婆罗门、切特里和马德西相比，达利特人参保的可能性较低（调整后的优势比 0.66；95%可信区间 0.47 至 0.94）。与来自第一省的家庭相比，来自第二省、巴格马蒂和苏德拉萨姆的家庭更不可能拥有会员资格。与来自最贫困财富五分位数的家庭相比，来自更富裕和最富裕五分位数的家庭拥有医疗保险的可能性高出两倍多。正的集中指数 0.25（95%可信区间 0.21 至 0.30；p<0.001）表明，富裕家庭的医疗保险参保率不成比例地更高。
户主的教育程度、接触大众媒体、宗教和族裔背景、地理位置（省份）和财富状况是尼泊尔医疗保险参保的主要预测因素。医疗保险参保存在显著的与财富相关的不平等。该研究建议定期监测医疗保险参保在人口和社会经济群体中的不平等情况，以确保在实现全民健康覆盖方面取得进展。
