Gurung Gaj Bahadur, Panza Alessio
College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.
PLOS Glob Public Health. 2022 Apr 4;2(4):e0000201. doi: 10.1371/journal.pgph.0000201. eCollection 2022.
Expanding membership coverage and retention of the National Health Insurance (NHI) programs among informal sector workers (ISWs) continues to be a significant challenge in most low and lower-middle-income countries (LMICs). The Nepal NHI program is also facing a similar problem, but to date, there are no studies that focus on identifying key predictors of annual membership renewal and retention in Nepal. This study therefore aimed to determine the predictors of intention to renew annual subscription to the NHI program among enrolled members. This cross-sectional quantitative study was part of a larger mixed-methods study conducted in three districts in Nepal. A random sample of 182 current NHI members and 61 dropped out NHI members who met the inclusion criteria were interviewed. The study's dependent variable was the intention to renew annual membership and employed univariate regression to assess the bivariate associations with the independent variables. The multivariate logistic regression examined the net effect of the independent variables on the odds of intention to renew. Our results showed that the household (HH) with high monthly income had lower odds of renewing their annual NHI membership (adjusted OR: 0.14, 95% CI: 0.03-0.58). Similarly, households (HHs) with overall health service satisfaction (adjusted OR:3.59, 95%CI: 1.23-10.43) and increased frequency of visits after NHI membership (adjusted OR: 10.09, 95% CI: 1.39-73.28) had high odds of renewing their membership. The top three dropout reasons were health services underutilization (43.3%), poor health services (26.9%), and the inadequacy of the benefits package (14.9%). Almost 64% of the respondents were willing to renew their membership upon improved services. The study found that the Nepal NHI annual membership renewal key predictors are HH income, health service quality, and health service utilization. Among these three key predictors, health service quality and service utilization were among the top three dropout reasons. The study, however, did not differentiate between moral hazards or actual service utilization, demanding further studies on the health service utilization of the insured members.
在大多数低收入和中低收入国家（LMICs），扩大国家健康保险（NHI）计划在非正规部门工人（ISWs）中的覆盖范围并提高其参保率仍然是一项重大挑战。尼泊尔的国家健康保险计划也面临类似问题，但迄今为止，尚无研究聚焦于确定尼泊尔年度参保续保和持续参保的关键预测因素。因此，本研究旨在确定参保成员中年度国家健康保险计划续保意愿的预测因素。这项横断面定量研究是在尼泊尔三个地区开展的一项规模更大的混合方法研究的一部分。研究人员对182名符合纳入标准的现有国家健康保险计划成员和61名退出该计划的成员进行了随机抽样访谈。该研究的因变量是年度参保续保意愿，并采用单变量回归来评估与自变量的双变量关联。多变量逻辑回归分析了自变量对续保意愿几率的净效应。我们的研究结果表明，月收入高的家庭（HH）续保年度国家健康保险计划的几率较低（调整后的比值比：0.14，95%置信区间：0.03 - 0.58）。同样，对整体医疗服务满意的家庭（HHs）（调整后的比值比：3.59，95%置信区间：1.23 - 10.43）以及参保后就诊频率增加的家庭（调整后的比值比：10.09，95%置信区间：1.39 - 73.28）续保几率较高。三大退保原因分别是医疗服务利用不足（43.3%）、医疗服务差（26.9%）以及福利套餐不完善（14.9%）。近64%的受访者表示，服务改善后愿意续保。该研究发现，尼泊尔国家健康保险计划年度参保续保的关键预测因素是家庭收入、医疗服务质量和医疗服务利用情况。在这三个关键预测因素中，医疗服务质量和服务利用情况位列三大退保原因之中。然而，该研究并未区分道德风险或实际服务利用情况，因此需要进一步研究参保成员的医疗服务利用情况。
