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Health Insurance and Maternal Healthcare Utilisation in Nepal: Evidence from the Nepal Demographic and Health Survey 2022
Yash Raj Lamsal, Abdulaziz Mohammed Hussen, Joyce Linda Browne, Reshu Agrawal Sagtani ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study used the 2022 Nepal Demographic and Health Survey to compare maternal health service use between women with and without health insurance. It looked at 2,078 women who had a live birth in the previous 24 months. Only 9.7% of them were insured. After statistical adjustment, insured women were more likely to attend at least four antenatal visits and to receive postnatal care. No clear difference was found for institutional delivery or skilled birth attendance.
Key points
- Of 2,078 women with a recent live birth, 201 (9.7%) were insured and 1,877 (90.3%) were uninsured.
- Insured women had higher odds of at least four antenatal care visits (AOR 2.14; 95% CI 1.15–3.98).
- Insured women had higher odds of a postnatal check-up within two days of delivery (AOR 2.05; 95% CI 1.28–3.27).
- Insured women had higher odds of postnatal care from a skilled provider (AOR 1.94; 95% CI 1.23–3.06).
- Associations with institutional delivery (AOR 1.55; 95% CI 0.91–2.62) and skilled birth attendance (AOR 1.57; 95% CI 0.90–2.72) were not statistically significant.
Limitations
The data come from a cross-sectional survey, so the study shows associations, not that insurance caused the differences. Only a small number of women were insured, and the study measured service use by mothers, not health outcomes for newborns or children.
Abstract
Abstract Background Access to maternal healthcare services is essential for improving maternal and neonatal health outcomes. Health insurance can reduce financial barriers to healthcare access and may facilitate utilisation of maternal health services, and contextualized evidence can further support policy development and implementation. This study assessed the association between health insurance coverage and utilisation of antenatal care (ANC), institutional delivery, skilled birth attendance and postnatal care (PNC) services among women in Nepal. Methods This study used data from the 2022 Nepal Demographic and Health Survey (NDHS), a nationally representative cross-sectional survey. The analysis included women aged 15–49 years who had a live birth within the 24 months preceding the survey. Inverse probability of treatment weighting (IPTW) based on propensity scores was applied to balance measured socioeconomic and demographic characteristics between insured and uninsured women. Weighted marginal structural models were used to estimate the association between health insurance coverage and maternal health-care utilisation outcomes. Robustness was assessed using alternative propensity score specifications and E-values for unmeasured confounding. Results Among 14,845 women interviewed, 2,078 reported a recent live birth and were included in the analysis (unweighted; 1,998 when survey-weighted). Of these, 201 (9.7%) had health insurance coverage and 1,877 (90.3%) were uninsured. After adjustment using IPTW, health insurance coverage was associated with significantly higher utilisation of maternal healthcare services. Insured women had more than twice the odds of attending at least four ANC visits compared with uninsured women (AOR 2.14; 95% CI 1.15–3.98). Similarly, insured women had higher odds of receiving a PNC check-up within two days of delivery (AOR 2.05; 95% CI 1.28–3.27) and receiving PNC from a skilled provider (AOR 1.94; 95% CI 1.23–3.06). Although insurance coverage was positively associated with institutional delivery (AOR 1.55; 95% CI 0.91–2.62) and skilled birth attendance (AOR 1.57; 95% CI 0.90–2.72), these associations did not reach statistical significance. Conclusion Health insurance coverage was associated with greater utilisation of antenatal and postnatal healthcare services among women in Nepal. However, no significant association was observed for institutional delivery or skilled birth attendance. Expanding health insurance coverage, particularly among underserved populations, may help improve maternal healthcare utilisation and support progress towards universal health coverage and maternal health-related Sustainable Development Goals.