Presentation (CTI)

OBJECTIVES: Nepal’s National Health Insurance Program (NHIP) was introduced to reduce financial barriers and improve healthcare utilization, yet the evidence on service-specific utilization patterns in peri-urban settings remains limited. The objective of this study was to compare overall and service-disaggregated healthcare utilization between insured and uninsured households in a peri-urban municipality in Nepal.
METHODS: A community-based comparative cross-sectional survey was conducted in Suryabinayak municipality, Bhaktapur. We selected 301 households (150 insured and 151 uninsured) using a two-stage stratified random sampling from five randomly selected wards. Healthcare utilization outcomes included overall service use, outpatient visits, diagnostic services, emergency care, inpatient admissions, and preventive services during the past six months. Data were analyzed using survey-weighted multivariable logistic regression, with confounders identified using a directed acyclic graph.
RESULTS: Overall, there was a significant difference in healthcare utilization between insured and uninsured households (74.7% vs 53.6%; p<0.001). Across services, there were significant differences in use of diagnostic (68.0% vs. 46.4%), outpatient (60.7% vs. 40.4%), emergency (12.7% vs. 4.6%), and inpatient services (19.3% vs. 9.3%) (all p < 0.05) among insured and uninsured, but not for preventive service (p=0.617). In adjusted models, NHIP enrollment was associated with higher odds of overall healthcare utilization (aOR 2.69; 95% CI 1.56 - 4.63), outpatient services (aOR 2.13; 95% CI 1.29 - 3.53), and diagnostic services (aOR 2.57; 95% CI 1.52 - 4.37). Chronic illness (aOR 3.90; 95% CI 2.18 - 6.99) and higher socioeconomic status (aOR 3.39; 95% CI 1.95 - 5.90) were the strongest predictors of utilization. NHIP enrollment was not associated with preventive service use (aOR 1.37; 95% CI 0.68 - 2.77).
CONCLUSIONS: NHIP enrollment was associated with higher diagnostic and curative service utilization but not preventive care. Findings suggest the need for equity-focused enrollment strategies and benefit-package reforms supporting preventive care while strengthening access for disadvantaged households.