The association between media exposure and enrollment in health insurance in Nepal: Implications for health policy

Psychosocial determinants of the willingness to pay for social health insurance among workers at a commercial bank in Dessie, Ethiopia: a multi-setting study

Background

A lack of health insurance is a major barrier to the "health for all" agenda, where out-of-pocket (OOP) spending is the primary healthcare funding mechanism, a characteristic of Ethiopia's healthcare sector, leading it to plan to fully implement social health insurance (SHI) by 2014, but not yet, owing to significant opposition from public employees. The objective of this study was to look into the psychosocial determinants of the willingness to pay (WTP) for SHI among employees at a commercial bank in Dessie, Ethiopia.

Methods

We employed a cross-sectional study (October to December 2023) design. A self-administered questionnaire was used to collect the data. We used SPSS 27 to analyze the data. The relationship between dependent and independent variables was determined using the odds ratios at a p value less than 0.05 with a 95% CI.

Results

Of 396 samples, 264 (66.7%) responded, of which 93.9% had information about SHI, mainly from broadcast media (71.0%). More than three-fourths (75.8%) and two-thirds (64.4%), respectively, had poor knowledge and a negative perception regarding SHI. More than half (50.4%) of the participants were willing to pay, of which 88.5% (40.5% of the total participants) were interested in paying the 3.0% premium set by the government. The main reason for the WTP was to help those who could not afford medical costs, while the primary reason for not paying was the scheme's limited benefit packages. The WTP was found to be significantly affected by being female (AOR = 0.50, 95% CI: 0.26-0.98), being affiliated with orthodox Christianity (AOR = 0.48, 95% CI: 0.23-0.99), the presence of ≥5 family members in the household (AOR = 0.17, 95% CI: 0.06-0.52), experience of illness in the last 6 months (AOR = 4.95, 95% CI: 2.23-11.00), and perception toward it (AOR = 4.07, 95% CI: 2.03-8.17).

Conclusion

The WTP for the scheme was suboptimal, attributed to limited benefit packages, lack of medicines and equipment, and poor healthcare quality, and significantly influenced by being female, being affiliated with orthodox Christianity, family size, experience of illness in the last 6 months, as well as perceptions toward it.

Mass Media Exposure Moderates the Association of Education and Wealth with Enrollment in Health Insurance Among Older Adults Aged 60 Years and Older in India

Mass media exposure (MME) plays an important role in changing health-related behavior or decision-making. This study aimed to examine the association of MME with enrollment in health insurance and its moderating effect on the associations of education and wealth with enrollment in health insurance among older adults in India. The data of 29,935 older adults aged 60 years and older from the first wave (baseline) of the Longitudinal Ageing Study in India (LASI-2017/18) were utilized. Descriptive statistics, bivariate analysis, multivariable logistic regression models, and Fairlie decomposition were used. The findings revealed that 18.3% of older adults had MME and enrollment in health insurance in India. Older adults with MME were 1.42 times more likely to be enrolled in health insurance than those with no MME, and years of schooling increased the probability of enrolling in health insurance compared to those who did not have formal schooling. With increasing monthly per capita expenditure (MPCE), the probability of enrolling in health insurance is lower than the poorest. Further, MME moderates the effects of education and MPCE on enrollment in health insurance and increases the likelihood of enrollment in health insurance. The study's findings imply strategic communication plans to encourage health insurance enrollment in India should take into account the usage of these communication channels.

Enrollment and associated factors of the national health insurance program of Nepal: Further analysis of the Nepal Demographic and Health Survey 2022

The focus of this study was on the current enrollment status of the government-funded health insurance (HI) program in Nepal, which is necessary to achieve universal health coverage by 2030. Despite the government's commitment, the program faces challenges of low enrollment and high dropout rates, hindering progress towards this goal. With a purpose to find out the associated factors for enrollment in HI, the cross-sectional study employs secondary data obtained from the Nepal Demographic and Health Survey 2022. A multi-stage sampling method yielded a representative sample of 14,280 households, and an interview was conducted with 14,845 females and 4,913 males aged 15-49. A weighted sample was employed and subsequently analyzed through the use of R. The analysis reveals a concerningly low enrollment rate, with only 10% of the surveyed population possessing government HI. Furthermore, significant geographical disparities were found to exist-Koshi Province had the highest coverage (21.8% men and 20.4% women), while Madhesh Province lagging far behind (3.1% men and 2.7% women). Additionally, the enrollment rates correlated positively with urban residence, higher socioeconomic statuses, and employment, with no subgroup surpassing 30% coverage, though. The study demonstrates a positive association between HI and healthcare utilization, with insured individuals exhibiting a higher likelihood of visiting health facilities and reporting fewer access-related issues. Respondents with higher levels of education and greater wealth were significantly more likely to enroll in HI than those with basic education and middle-level wealth, respectively. This pattern holds consistently for both males and females. These findings suggest that the program, aiming for 60% coverage by 2023/24, is currently off-track. Policymakers should interpret these data as a call for action, prompting the development and implementation of the targeted interventions to address enrollment disparities across Nepal. By focusing on the low-coverage areas and the vulnerable populations, the program can be strengthened and contribute meaningfully to achieving universal health coverage by 2030.