Factors Associated with Enrollment in Social Health Insurance in Sundarharaicha Municipality, Morang, Nepal

Abstract

Background: The government of Nepal introduced the Social Health Insurance (SHI) program to improve access to health services and to reduce out-of-pocket health expenses of the people. The program aims to pool financial resources to provide health-care coverage and subsidies to people. It aims to prevent people from financial hardship at healthcare center while getting treatment. It provides support for quality health services. Only a few studies have been conducted on an enrollment status of SHI in Nepal.

Objectives: The main aim of this research is to identify the significant socio-demographic and health-related factors towards the enrollment status of Social Health Insurance Program of Sundarharaicha Municipality Morang, Nepal.

Materials and Methods: The study was based on a cross-sectional study design in three wards of Sundarharaicha Municipality in Morang district. The study was entirely based on primary data among 392 households using a structured questionnaire and data were directly collected from individuals using the personal interview method.

The findings of the study consist of both descriptive as well as inferential results. Descriptive analysis, chi-square tests, Fisher exact test, and binary logistic regression were used to analyze relationships among enrollment status and socio-demographic variables. Internal consistency of awareness items was assessed using Cronbach’s alpha.

Results: The majority of respondents (52.6%) were enrolled on SHI. From bivariate analysis, enrollment was significantly associated with variables such as age, education status, chronic illness, family history of chronic illness, monthly income, awareness on health insurance, and heard about government insurance (p < 0.05). A binary logistic regression identified educational level, awareness, and chronic illness of household’s head as key factors associated with enrollment status. Both forward and backward likelihood ratio methods were used and the same result was obtained

Conclusion: This study identified factors associated with enrollment status towards social health insurance (SHI). A binary logistic regression analysis identified educational level, awareness, and chronic illness of household’s head as the key factors associated with SHI.