Factors Associated to the Enrollment in Health Insurance: An Experience from Selected Districts of Nepal

Abstract

The enrollment in Health Insurance (HI) is considered as a sustainable way of financing for health and preparedness for catastrophic health care cost during receiving health services. Various socio-demographic factors are still unanswered regarding their influence. A study aiming to assess the factors associated with the enrollment of HI was conducted in 2018 in two districts of Nepal namely Kailali and Baglung. The study was cross-sectional covering 810 (405 enrolled and 405 not-enrolled) randomly selected households (HH). Socio-demographic variables were considered as independent variables and enrollment in HI as dependent variable. An interview schedule was used as a tool for data collection. Univariate, bivariate and multivariate analyses were performed to analyze the data. The data show that various socio-demographic characteristics are associated with the enrollment of HI. A significant statistical difference is seen between enrollment to HI and HH headship, age group of respondents, ability to feed the family, presence of chronic diseases in family, knowledge on HI, willingness to pay (WTP) for HI, having HI guidelines or books, participation in HI related training, interactions with neighbours, access to communication media: the radio/FM and TV, hoarding boards (HB), newspapers, posters/pamphlets/brochures; and access to health facilities. The results further show that female heads appear more likely to enroll (aOR = 1.47) in HI than the male. HH headship of the respondents also seem more likely to enroll. Higher age respondents are less likely to enroll. Interestingly, literate respondents and joint families are less likely to enroll than illiterate and nuclear families respectively. However, respondents having knowledge in HI seem more likely to enroll (aOR = 28.97, p1.673, p