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Introduction <p>Nepal’s Health Insurance Program (HIP) faces low enrolment and poor renewal rates, threatening its suitability. This paper aims to find out the current situation and associated factors for enrolment in health insurance (HI).</p> Methods <p>This study used secondary data from the Nepal Demographic and Health Survey (NDHS) 2022 for calculation and Health Insurance Board [HIB] reports for enrolment and renewal status. Binary logistic regression analysis was carried out using complex sample analysis.</p> Results <p>The study included 4913 men and 14,845 women from NDHS 2022. Only 12–13% of those aged 15–49 were insured, though the HIB report states that one-third of the households and one-fourth of the population were enrolled with a 69% renewal rate. Age group of 15–19 years [AOR:0.488(0.302–0.789) for men, AOR:0.494(0.339–0.721) for women], no education [AOR:0.139(0.060–0.323) for men, AOR:0.223(0.157–0.316) for women], poorest [AOR:0.240(0.139–0.414) for men, AOR:0.205(0.139–0.303) for women], female household head [AOR:0.818(0.686–0.974)] and currently not working [AOR:0.777(0.654–0.922) for women] were noticed to be lower adjusted odds ratios (AOR) for enrolment in HI. Whereas use of internet [AOR:1.510(1.103–2.067) for men, AOR:1.223(1.013–1.476) for women], and self-reported health status [AOR:1.441(1.179–1.761) for women] showed a higher AOR for enrolment in HI compared to their respective reference category.</p> Conclusion <p>The HIP has not effectively engaged socially and economically active adults aged 15–49. It requires quality healthcare, HI literacy through schools, households, and hospitals. Moreover, provision for progressive taxes for health-compromising goods and services, offering multiple coverage and a one-door system, is essential for the program’s sustainability.</p>

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Status of health insurance enrolment in Nepal and way forward for policy reform

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月9日

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  • Devaraj Acharya,
  • Om Chandra Thasineku,
  • Bhimsen Devkota,
  • Radha Bhattarai,
  • Suman Kharel,
  • Krishna Bahadur Thapa

摘要

Introduction

Nepal’s Health Insurance Program (HIP) faces low enrolment and poor renewal rates, threatening its suitability. This paper aims to find out the current situation and associated factors for enrolment in health insurance (HI).

Methods

This study used secondary data from the Nepal Demographic and Health Survey (NDHS) 2022 for calculation and Health Insurance Board [HIB] reports for enrolment and renewal status. Binary logistic regression analysis was carried out using complex sample analysis.

Results

The study included 4913 men and 14,845 women from NDHS 2022. Only 12–13% of those aged 15–49 were insured, though the HIB report states that one-third of the households and one-fourth of the population were enrolled with a 69% renewal rate. Age group of 15–19 years [AOR:0.488(0.302–0.789) for men, AOR:0.494(0.339–0.721) for women], no education [AOR:0.139(0.060–0.323) for men, AOR:0.223(0.157–0.316) for women], poorest [AOR:0.240(0.139–0.414) for men, AOR:0.205(0.139–0.303) for women], female household head [AOR:0.818(0.686–0.974)] and currently not working [AOR:0.777(0.654–0.922) for women] were noticed to be lower adjusted odds ratios (AOR) for enrolment in HI. Whereas use of internet [AOR:1.510(1.103–2.067) for men, AOR:1.223(1.013–1.476) for women], and self-reported health status [AOR:1.441(1.179–1.761) for women] showed a higher AOR for enrolment in HI compared to their respective reference category.

Conclusion

The HIP has not effectively engaged socially and economically active adults aged 15–49. It requires quality healthcare, HI literacy through schools, households, and hospitals. Moreover, provision for progressive taxes for health-compromising goods and services, offering multiple coverage and a one-door system, is essential for the program’s sustainability.