Research Centre for Educational Innovation and Development [CERID], Tribhuvan University, Kathmandu, Nepal.
Prithvi Narayan Campus, Tribhuvan University, Pokhara, Nepal.
PLoS One. 2024 Oct 3;19(10):e0310324. doi: 10.1371/journal.pone.0310324. eCollection 2024.
The focus of this study was on the current enrollment status of the government-funded health insurance (HI) program in Nepal, which is necessary to achieve universal health coverage by 2030. Despite the government's commitment, the program faces challenges of low enrollment and high dropout rates, hindering progress towards this goal. With a purpose to find out the associated factors for enrollment in HI, the cross-sectional study employs secondary data obtained from the Nepal Demographic and Health Survey 2022. A multi-stage sampling method yielded a representative sample of 14,280 households, and an interview was conducted with 14,845 females and 4,913 males aged 15-49. A weighted sample was employed and subsequently analyzed through the use of R. The analysis reveals a concerningly low enrollment rate, with only 10% of the surveyed population possessing government HI. Furthermore, significant geographical disparities were found to exist-Koshi Province had the highest coverage (21.8% men and 20.4% women), while Madhesh Province lagging far behind (3.1% men and 2.7% women). Additionally, the enrollment rates correlated positively with urban residence, higher socioeconomic statuses, and employment, with no subgroup surpassing 30% coverage, though. The study demonstrates a positive association between HI and healthcare utilization, with insured individuals exhibiting a higher likelihood of visiting health facilities and reporting fewer access-related issues. Respondents with higher levels of education and greater wealth were significantly more likely to enroll in HI than those with basic education and middle-level wealth, respectively. This pattern holds consistently for both males and females. These findings suggest that the program, aiming for 60% coverage by 2023/24, is currently off-track. Policymakers should interpret these data as a call for action, prompting the development and implementation of the targeted interventions to address enrollment disparities across Nepal. By focusing on the low-coverage areas and the vulnerable populations, the program can be strengthened and contribute meaningfully to achieving universal health coverage by 2030.
本研究的重点是尼泊尔政府资助的健康保险(HI)计划的当前参保状况,这对于实现 2030 年全民健康覆盖目标是必要的。尽管政府做出了承诺,但该计划面临参保率低和高退保率的挑战,阻碍了实现这一目标的进展。为了找出 HI 参保的相关因素,这项横断面研究采用了 2022 年尼泊尔人口与健康调查的二级数据。多阶段抽样方法产生了一个有代表性的 14280 户家庭样本,对 15-49 岁的 14845 名女性和 4913 名男性进行了访谈。采用加权样本,并通过使用 R 进行分析。分析结果显示,参保率令人担忧地低,只有 10%的调查人口拥有政府 HI。此外,还发现存在显著的地域差异——科希省的覆盖率最高(男性为 21.8%,女性为 20.4%),而马德什省则远远落后(男性为 3.1%,女性为 2.7%)。此外,参保率与城市居住、较高的社会经济地位和就业呈正相关,尽管没有任何一个亚组的覆盖率超过 30%。研究表明,HI 与医疗保健的利用之间存在正相关,参保者更有可能访问医疗机构,并报告较少的获取相关问题。受教育程度较高和财富较多的受访者比受教育程度较低和财富中等的受访者更有可能参加 HI,这种模式在男性和女性中都是一致的。这些发现表明,该计划旨在 2023/24 年实现 60%的覆盖率,目前已经偏离了轨道。政策制定者应将这些数据视为采取行动的呼吁,促使制定和实施有针对性的干预措施,以解决尼泊尔各地的参保差距。通过关注低覆盖率地区和弱势群体,该计划可以得到加强,并为实现 2030 年全民健康覆盖目标做出有意义的贡献。