Low coverage of health insurance in rural Nepal threatens Nepals goal to achieve Universal Health Coverage by 2030.Government health insurance scheme in Nepal is voluntary and family-based.So, exploring the factors influencing the enrolment at household-level is important to design policies targeting coverage expansion.Thus, this study examines the socioeconomic, geographical, and decision-making factors associated with household insurance enrolment in Lumbini Province of Nepal.This study used 2022 Nepal Demographic and Health Survey data and analysed 1,673 weighted households of Lumbini Province by applying survey-weighted logistic regression.In 2022, health insurance coverage among households in Nepal was 13.3% and in Lumbini Province, it was found to be low at 11.4%.Empirical evidence reveals that the richest households have significantly higher odds of enrolment compared to the poorest.Households from marginalized caste have significant lower odds than Hill Brahmin/Chhetri.Insurance coverage was significantly higher in Palpa, Arghakhanchi, and Gulmi districts.Households with educated heads, larger size, and limited female healthcare decision-making were more likely to enrol in the scheme.These findings exhibit disparities in insurance uptake by wealth, ethnicity, geography, education of household head, and gender dynamics in family.Therefore, to increase participation in National Health Insurance Program, the government should focus on financially disadvantaged and marginalized households with financial subsidies and targeted outreach, and address gender and caste related social barriers.
Bhurtel et al. (Fri,) studied this question.