Socio-demographic Effects on Enrollment in the Social Health Insurance Program in Nepal: A Case of Kathmandu Metropolitan City Ward No. 30

Abstract

Background: Social Health Insurance (SHI) coverage in Nepal remains sort of low despite national efforts toward universal health coverage. This study examined demographic influences on SHI enrollment in Ward 30 of Kathmandu Metropolitan City.

Methods: Secondary aggregate data (N=1,379 valid enrollees) were pretty much obtained from the Urban Health Promotion Centre’s SHI promotion campaign conducted in mid-July 2024. descriptive statistics and chi-square goodness-of-fit tests were used to compare enrollee distributions by age, gender, and marital status against 2021 census proxies for Kathmandu Metropolitan City.

Result:The study used secondary data, which it collected from 1,379 people who lived in Ward 30, Kathmandu, during mid-July 2024 and found that 83.8% of them enrolled in the Social Health Insurance (SHI) program. The enrollment rate for females reached 90.0%, whereas males showed a lower rate of 74.9% (χ² = 56.706, df = 1, p < 0.001). The enrollment rate reached its highest point of 96.3% among people who belonged to the 56–65 years age group, while only m62.0% of people from the 18–25 years age group enrolled (χ² = 135.169, df = 5, p < 0.001). The enrollment rates for widowed respondents reached 87.6% and married respondents reached 85.7%, while single respondents reached only 61.8% (χ² = 48.774, df = 2, p < 0.001). The sample group showed a higher representation of older adults who entered marriage than the actual population, which maintained an almost equal gender distribution and contained many people between 15 and 59 years of age.

Conclusion: The study found that SHI enrollment in Ward 30 depends on three demographic factors, which include gender, age and marital status. The study shows that women and older people, and married or widowed individuals, show higher participation rates because they have greater health requirements, which result from their family obligations. The study shows that three groups, which include men, young people and single people, show lower enrollment rates because they create participation barriers. The country needs to execute targeted campaigns which consider gender and age demographics to create better health coverage for its population while working towards complete health coverage for all citizens. The Urban Health Promotion Centre campaign, which operated in specific local areas, achieved higher participant rates than the national average, which stands at 10 to 13 per cent.