Enhancing willingness and enrollment in the national health insurance program in Madhesh Province, Nepal

PurposeThis study investigates the willingness of household heads in Madhesh Province, Nepal, to enroll in the National Health Insurance Program (NHIP) and examines the contextual barriers that may hinder this enrollment.Design/methodology/approachA quantitative cross-sectional study was conducted with 319 household heads through face-to-face interviews from May 15 to June 13, 2023. The ability, motivation and opportunity (AMO) framework guided the assessment, employing bivariate and multivariate binary logistic regression analyses to identify significant factors influencing willingness.FindingsOver 80% of respondents were willing to enroll in NHIP, driven by significant factors such as perceived susceptibility to health issues (AOR = 15.65) and knowledge about NHIP benefits (AOR = 2.20). However, contextual barriers such as the lack of enrollment assistants (73%) and inadequate healthcare package offerings (53%) were prevalent, highlighting that despite a strong desire to enroll, these barriers prevent many from taking action.Research limitations/implicationsThe findings highlight the need to address contextual barriers, such as expanding NHIP benefit packages and enhancing enrollment support, to convert willingness into action.Practical implicationsTo enhance enrollment rates, it is crucial to address these barriers by increasing the availability of enrollment assistants and improving healthcare packages.Social implicationsStrengthening NHIP can reduce high out-of-pocket expenditures and contribute to achieving universal health coverage in Nepal.Originality/valueThis study provides critical insights into the factors affecting NHIP enrollment in one of Nepal's lowest-enrollment regions, offering actionable recommendations for policy improvements.