Patient satisfaction with the components of the National Health Insurance Program of Nepal: a cross-sectional study

BACKGROUND: Patient satisfaction is increasingly recognized as a key measure of quality care, reflecting patients’ judgments on its quality and effectiveness. Ensuring that patient expectations and needs are met is a professional responsibility of healthcare providers. This study aims to assess the satisfaction of patients enrolled in the National Health Insurance Program (NHIP) across its various components. METHODS: We conducted a cross-sectional study at 22 health facilities across 3 provinces of Nepal. We utilized client-exit interviews among 468 patients enrolled and utilizing the health services under NHIP using convenience sampling. We used a Health Insurance Satisfaction Questionnaire (HISQ) incorporating the various dimensions of the NHIP along with various contextual sociodemographic characteristics. We calculated mean score and percentages of patient satisfaction across the four domains of health insurance. To determine the association between various dimensions of patient satisfaction and sociodemographic characteristics of the patient, we used multi-ordinal logistic regressions. RESULTS: Among 468 patients, the mean age was 46 ± 16 years and over half (57.9%) had attained a secondary or higher level of education. Most respondents (76.5%) had been enrolled in the National Health Insurance Program (NHIP) for over one year, with 18.8% enrolled as a subsidized group. Regarding the satisfaction level of insured clients with NHIP, highest proportion (98.9%) of satisfied patients were in service utilization. Similarly, the domains of knowledge and administrative had satisfaction rates of 70.1% and 85.5% respectively. Conversely, satisfaction rate was observed lowest in service availability domain (60.7%). Sociodemographic factors influenced knowledge of NHIP, with education above secondary level (AOR: 7.71; 95% CI: 3.39–17.50) and age over 60 years (AOR: 1.56; 95% CI: 1.05–2.32) being significant predictors. Other sociodemographic variables such as family size, subsidy status, and occupation were associated with multiple dimensions of satisfaction (p < 0.05). CONCLUSION: As lower satisfaction in the service availability and knowledge domains were identified, it is essential to maintain and disseminate information about the NHIP schemes across the country. Additionally, consistent monitoring and supply of medicines and drugs can help restore consumer trust in the insurance program, as many are currently burdened by out-of-pocket expenses for these necessities despite being enrolled as NHIP beneficiaries.