The Trends and Determinants of Continuity in the Government Health Insurance Program

Abstract

Background: Nepal Government Health Insurance enrollment has increased, and sustaining continuous coverage remains difficult. Health insurance continuity is changed by social, household, and service-related factors. This study assessed trends in continuity among insured households in Gandaki Province and the associated factors.
Methods: A cross-sectional survey was conducted among 411 insured individuals. Data was collected using a structured questionnaire. Participants’ characteristics and continuity patterns were summarized using descriptive statistics. Determinants of continuity in health insurance program were investigated through bivariate and multivariate logistic regression analyses.
Results: The mean age of respondents was 46.4 years; most were Hindu and over half had a bachelor’s degree or higher. While 92.5% intended to renew their insurance annually, only 16.3% discontinuous enrollment. Discontinuation was primarily due to poor service quality, low perceived need, and limited awareness. Continuity of enrollment was significantly associated with ethnicity (AOR 3.63), source of drinking water (AOR 0.32), female involvement in household health decision-making (AOR 3.63), and use of private health facilities (AOR 0.12). No independent predictors of discontinuation were identified after adjustment.
Conclusion: The study identified a notable gap between high intentions to renew health insurance and actual continuity of enrollment in Gandaki Province. Although Most respondents intended to renew their insurance. Continuity was influenced by socio-cultural factors, household decision-making, and service utilization, while dropout is driven by system and service delivery challenges. Improving service quality, user experience, benefit alignment, and community awareness is essential for sustaining the program.
Keywords: Determinants; Enrollment Retention; Health Insurance; Healthcare Utilization; Insurance Continuity; Nepal