What determines health insurance ownership in Nepal? Findings from the Nepal multiple indicator cluster survey 2019

ObjectiveIn Nepal, various health insurance schemes including community-based and national health insurance programmes have been implemented to reduce financial burdens on the population and improve access to health care, towards the goal of Universal Health Coverage. Despite these efforts, there are limited studies on health insurance ownership in Nepal. This study aimed to determine factors influencing insurance ownership at individual and household level in Nepal.Study designThis study utilized cross-sectional data from the Nepal Multiple Indicator Cluster Survey 2019, a nationally representative survey. This paper reports on analysis of data from 14,769 women and 5491 men aged 15-49 years and 4113 households, using logistic regression and the Cragg hurdle model.ResultsThe study found that less than 6% of respondents had health insurance: 5.8% of women (95% CI 4.82 - 6.88) and 5.1% of men (95%CI: 4.5 - 5.8), with higher rates among older women with higher education, belonging to the Newar ethnic group, and living in urban areas. Age and education were significant predictors of individual insurance ownership. Higher socio-economic status of the household and higher education of the individual were associated with greater likelihood of insurance ownership, while belonging to disadvantaged ethnicities and living in the Sudurpaschim and Madhesh provinces were associated with lower likelihood of insurance ownership.ConclusionHealth insurance ownership is low in Nepal, particularly among disadvantaged ethnicities and low socio-economic status households. Efforts to increase health insurance coverage need to focus on addressing the inequities related to socio-economic status, ethnicity, and regions. Further research is necessary to identify reasons for lower coverage among the specific population groups.