Information, Education and Communication for Enrolment in Health Insurance in Nepal

Abstract

The health insurance [HI] programme is novel for Nepalese people and it needs information, education, and communication [IEC] related intervention for raising awareness regarding HI. Though, it was unanswered that which methods or approach would be the best to make people aware and for enrolment of HI. Therefore, the study aimed to assess IEC for the enrolment of HI in Baglung and Kailali Districts of Nepal. Altogether 810 [405 enrolled and 405 non-enrolled] households were randomly selected from Baglung and Kailali Districts in 2018. A validated and structured interview schedule was used to collect information, particularly from household heads. Data were entered and analysed by using IBM SPSS Statistics 20. Ethical approval was obtained from the Nepal Health Research Council. Data show that the average amount of willingness to pay [WTP] for HI was NRs. 1429 per member per year which was about three-fold higher than the contribution amount the GoN has determined. There was a positive association between wealth status, educational status, and exposure to IEC, and WTP for HI. Similarly, there was an association between socio-demographic characteristics and enrolment of HI. Exposure to IEC was significantly associated with the enrolment of HI. Likewise, perceived susceptibility and severity about the consequences of diseases or illness were associated with the enrolment. Therefore, the study supported the HBM constructs mainly susceptibility and severity of diseases or illness with empirical evidence. The respondents who knew were noticed as 25.8 times higher odds compared to those who had not (p<0.001). Similarly, the respondents who had HI related books or guidelines were observed as higher odds (aOR = 4.66, 95% CI: 2.52 – 8.64, p<0.001). In the same way, the respondents who were requested to enrol by peers or neighbours were almost five times (aOR = 5.04, 95% CI: 3.25 – 7.80, p<0.001) more likely to enrol than those who were not requested. Multivariate analysis showed that communication with IV

peers or neighbours seemed a more powerful approach for decision making or behaviour change. It indicates that peers or neighbours may be used for formal or non-formal educational intervention to motivate people such as adult literacy, health literacy, and other health-related campaigns.