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What factors influence enrolment in Nepal's National Health Insurance Program? A community-based cross-sectional
Anil Paudel1, Richa Acharya2, Pratik Khanal3,4
1Central Institute of Science and Technology (CiST) College, Kathmandu, Nepal.
BMJ Public Health
|June 25, 2026
Summary
Understanding health beliefs is key to improving Nepal's National Health Insurance Program (NHIP) enrolment. Social influence and perceived illness risk significantly drive enrolment, while affordability and access remain barriers.
Area of Science:
- Health Policy and Economics
- Public Health
- Behavioral Science
Background:
- Government initiatives like the National Health Insurance Program (NHIP) in Nepal aim to expand healthcare access.
- Suboptimal enrolment rates indicate a need to understand underlying behavioural, psychological, and social factors.
- The Health Belief Model (HBM) provides a framework for assessing these influencing factors.
Purpose of the Study:
- To assess the factors influencing enrolment in Nepal's National Health Insurance Program (NHIP).
- To identify facilitators and barriers to NHIP enrolment using the Health Belief Model (HBM).
Main Methods:
- A community-based cross-sectional study was conducted in Panini Rural Municipality, Arghakhanchi district, Nepal.
- Data were collected from 360 randomly selected households via face-to-face interviews using an HBM-guided questionnaire.
- Logistic regression analysis was employed to identify significant predictors of enrolment.
Main Results:
- Perceived susceptibility and severity of illness, along with recent illness experience, significantly increased NHIP enrolment likelihood.
- Strong knowledge of NHIP and perceived affordability of premiums were key facilitators.
- Social influences, including peer enrolment, neighbour encouragement, and family agreement, strongly predicted enrolment.
- Barriers included inconvenient premium collection, perceived lack of necessity, limited service points, and referral card requirements.
Conclusions:
- Targeted interventions should leverage social networks to enhance awareness and promote NHIP enrolment.
- Addressing barriers related to premium affordability and referral processes is crucial for improving enrolment rates.
- Further exploration of flexible payment mechanisms and streamlined referral systems is recommended.
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