Does perceived susceptibility and severity of health problems serve as drivers for household enrolment in health insurance? A case study from Nepal

Acharya, Devaraj; Maharjan, Shyam Krishna; Kreps, Gary L.

doi:10.1002/hpm.3377

Cited by 7 publications

(11 citation statements)

References 31 publications

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“…One weakness of the paper is absence of some key variables like severity of diseases or the diseases suffered by the individuals in Malawi. These variables have been reported in other settings as being key drivers of uptake of health insurance [30]. The other limitation of this study is that the numbers of individuals that had a health insurance in Malawi was very low hence we could not perform a multivariate analysis.…”

Section: Discussionmentioning

confidence: 93%

Uptake of health insurance in Malawi in 2019-2020: Evidence from the Multiple Indicator Cluster Survey

Ng’ambi

Chigaru

Mwase

et al. 2022

Preprint

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Introduction: Although countries in sub-Sahara Africa (SSA) show progress in implementing various forms of health insurance, there is a dearth of information regarding health insurance in settings like Malawi. Therefore, we conducted this study to determine the uptake of health insurance and describe some of the factors associated with the prevailing uptake of health insurance in Malawi using the 2019-20 Multiple Indicator Cluster Survey (MICS). Methods: This was a secondary analysis of the 2019-20 MICS data. Data were analysed using frequencies and weighted percentages in Stata v.17. Furthermore, since the number of persons with health insurance is very small, we were unable to perform multivariate analysis. Results: A total of 205 (1%) of the 31259 had health insurance in Malawi in 2019-20. Of the 205 individuals that owned health insurance, 118 (47%) had health insurance through their employers while 39 (16%) had health insurance through mutual health organization or ccommunity-based. Men had higher uptake of health insurance than the women. The residents from urban areas were more likely to have a health insurance than those in the rural areas. Persons with media exposure were more likely to own health insurance as compared to their counterparts. There was increasing trend in the uptake of health insurance by wealth of the individual with the poorest being less likely to have health insurance compared to the richest. The persons with no education being least likely to have a health insurance while those with tertiary education were most likely to have health insurance. Conclusion: The uptake of health insurance in Malawi was extremely low. In order to increase the uptake of health insurance, there is need to increase insurance coverage amongst those in formal employment, consider minimizing the geographic, economic and demographic barriers in accessing the health insurance.

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Section: Discussionmentioning

confidence: 93%

Uptake of health insurance in Malawi in 2019-2020: Evidence from the Multiple Indicator Cluster Survey

Ng’ambi

Chigaru

Mwase

et al. 2022

Preprint

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“…However, peers' requests to register in HI, discussions with relatives, and family members' approval of enrolment were the most significant predictors of enrolment. These factors may be incorporated into future intervention plans for increasing enrolment in HI ( 43 ). Local governments and stakeholders can play an important role.…”

Section: Discussion and Prospectsmentioning

confidence: 99%

“…In line with this, a willingness to pay for the program is substantially related to awareness of the scheme. It is influenced in part by social capital and awareness of the Community Based Health insurance initiative ( 43 ). Thus, it is evident that social cohesiveness and solidarity in local communities are vital to raising awareness of the benefits of the CBHI and, thus, in SHIP and other social security programs.…”

Section: Discussion and Prospectsmentioning

confidence: 99%

Adopting social health insurance in Nepal: A mixed study

Paneru

Adhikari

Poudel

et al. 2022

Front. Public Health

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ObjectiveThe Social Health Insurance Program (SHIP) shares a major portion of social security, and is also key to Universal Health Coverage (UHC) and health equity. The Government of Nepal launched SHIP in the Fiscal Year 2015/16 for the first phase in three districts, on the principle of financial risk protection through prepayment and risk pooling in health care. Furthermore, the adoption of the program depends on the stakeholders' behaviors, mainly, the beneficiaries and the providers. Therefore, we aimed to explore and assess their perception and experiences regarding various factors acting on SHIP enrollment and adherence.MethodsA cross-sectional, facility-based, concurrent mixed-methods study was carried out in seven health facilities in the Kailali, Baglung, and Ilam districts of Nepal. A total of 822 beneficiaries, sampled using probability proportional to size (PPS), attending health care institutions, were interviewed using a structured questionnaire for quantitative data. A total of seven focus group discussions (FGDs) and 12 in-depth interviews (IDIs), taken purposefully, were conducted with beneficiaries and service providers, using guidelines, respectively. Quantitative data were entered into Epi-data and analyzed with SPSS, MS-Excel, and Epitools, an online statistical calculator. Manual thematic analysis with predefined themes was carried out for qualitative data. Percentage, frequency, mean, and median were used to describe the variables, and the Chi-square test and binary logistic regression were used to infer the findings. We then combined the qualitative data from beneficiaries' and providers' perceptions, and experiences to explore different aspects of health insurance programs as well as to justify the quantitative findings.Results and prospectsOf a total of 822 respondents (insured-404, uninsured-418), 370 (45%) were men. Families' median income was USD $65.96 (8.30–290.43). The perception of insurance premiums did not differ between the insured and uninsured groups (p = 0.53). Similarly, service utilization (OR = 220.4; 95% CI, 123.3–393.9) and accessibility (OR = 74.4; 95% CI, 42.5–130.6) were found to have high odds among the insured as compared to the uninsured respondents. Qualitative findings showed that the coverage and service quality were poor. Enrollment was gaining momentum despite nearly a one-tenth (9.1%) dropout rate. Moreover, different aspects, including provider-beneficiary communication, benefit packages, barriers, and ways to go, are discussed. Additionally, we also argue for some alternative health insurance schemes and strategies that may have possible implications in our contexts.ConclusionAlthough enrollment is encouraging, adherence is weak, with a considerable dropout rate and poor renewal. Patient management strategies and insurance education are recommended urgently. Furthermore, some alternate schemes and strategies may be considered.

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“…Health beliefs play an important role in leading people to engage in preventive health behavior (Acharya et al, 2022; Chen et al, 2022; Kissal & Kartal, 2019) and the health belief model is a frequently used model in the field of health education and health promotion to determine how perceptions about particular health behaviors influence members of vulnerable populations. Six health belief model (HBM) constructs (perceived susceptibility, severity, benefits, barriers, cues to action, and self‐efficacy) help determine the different levels of perception of the health problems (Champion & Skinner, 2008).…”

Section: Introductionmentioning

confidence: 99%

Implications from the health belief model concerning zoonoses‐related threat perceptions held by livestock farmers in Nepal

Bagale

Adhikari

Acharya

et al. 2023

World Med & Health Policy

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Diseases that can be spread from animals to humans (zoonoses) are neglected health issues in Nepal. Due to professional exposure, livestock farmers are highly vulnerable to zoonoses. However, since there are limited studies, we have virtually no actual evidence on perception and practices toward prevention and response to zoonoses by livestock farmers in Nepal. This study examines the association between zoonoses preventive practices and the threat perceptions held by livestock farmers in Nepal based upon applications of health belief model (HBM) constructs. A descriptive cross‐sectional quantitative interview‐based survey was conducted with 380 livestock farmers randomly selected from three districts in Nepal. Results show that livestock farmers held primarily strong beliefs about zoonoses based on key constructs from the Health Belief Model (susceptibility, severity, benefits, and barriers with 91.5%, 93.7%, 91.1%, and 41.0%, respectively). However, they described low levels of participation in zoonoses preventive practices, such as handwashing with soap and water (52%–59%), following prescribed sick animal consumption practices (6.6%–17.7%), raw meat consumption practices (1.6%–6.3%), engaging in vaccination practices for livestock (33.9%–38.2%), and maintaining distance between home and shed (2.1%–13%). Based upon these findings, we strongly recommend enacting strategies to minimize the gaps between zoonoses preventive practices and perceptions through targeted communication interventions that include optimal educational sessions to reinforce applications from the constructs of HBM in farming communities.

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Does perceived susceptibility and severity of health problems serve as drivers for household enrolment in health insurance? A case study from Nepal

Cited by 7 publications

References 31 publications

Uptake of health insurance in Malawi in 2019-2020: Evidence from the Multiple Indicator Cluster Survey

Uptake of health insurance in Malawi in 2019-2020: Evidence from the Multiple Indicator Cluster Survey

Adopting social health insurance in Nepal: A mixed study

Implications from the health belief model concerning zoonoses‐related threat perceptions held by livestock farmers in Nepal

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