Status and associated factors of health insurance enrollment among women in Nepal

The Government of Nepal (GoN) introduced a Health Insurance Program (HIP) in 2016 aiming to ensure quality healthcare for all Nepalese citizens without financial hardship. However, the HIP has not attracted as many people as expected. It shows low enrollment and high dropout rates. Studies on this issue are scarce, particularly regarding women. To identify the factors associated with women enrollment in health insurance (HI), this study utilized a cross-sectional design, analyzing secondary data (n = 14,845) from the Nepal Demographic and Health Survey 2022. Chi-square test and logistic regression were used to identify associations with women participation in the HIP. Women enrollment in HI was positively and significantly associated with province, age, ethnicity, educational level, religion, place of residence, ecological region, wealth index, women's autonomy in household decisions, household head status, and current employment (p < 0.01). Socioeconomic and demographic factors of the respondents, such as being over 35 years old (aOR = 1.98; 95% confidence interval [CI]: 1.65-2.39), having a secondary or higher education (aOR = 2.96; 95% CI: 2.43-3.64), being currently employed in a paid job (aOR = 1.31; 95% CI: 1.17-1.47), and belonging to the richest wealth status (aOR = 5.64; 95% CI: 4.33-7.34), were more likely to be enrolled in the HIP compared to their respective reference groups. In conclusion, being of privileged socioeconomic status, belonging to a specific ethnic group, having a higher educational level, being employed, and living in the Mountain region are all associated with women enrollment in HIP. Policymakers may consider these findings when planning and implementing future interventions.