DETERMINANTS AND IMPACT OF HEALTH INSURANCE ON UTILIZATION OF MATERNAL HEALTH CARE IN NEPAL

Sharad Kumar Sharma, National Statistics Office
Sulabh Ghimire, CIST College
Keshab Deuba, 3Public Health and Environment Research Centre (PERC) Nepal, 4Department of Global Public Health, Karolinska Institute

Nepal reduced its maternal mortality rate by 3.7% annually from 1996 to 2016, but significant efforts are still required to meet the Sustainable Development Goal target of 70 per 100,000 live births by 2030. This study analyzes the determinants and impact of health insurance on maternal health service utilization (ANC 4 visits, skilled birth attendant (SBA) delivery, caesarean section (CS) delivery, and postnatal care (PNC) for the baby) among 1,950 women using data from the latest Nepal Multiple Indicator Cluster Survey. Andersen’s model of health service use identified predisposing, enabling, and need factors influencing these outcomes, with adjustments made for the survey's design. Findings show that 78% of women received four or more ANC visits, 77% had SBA during delivery, 15% underwent CS, and 68% received PNC. Education was the strongest predictor of ANC visits, SBA delivery, and PNC, while ethnicity and age were significant factors in service utilization. Household wealth was a key enabler of access to all maternal health services. Health insurance coverage positively influenced SBA and CS deliveries, with impacts of 10% and 5%, respectively. Expanding health insurance to marginalized groups and improving rural maternal health service accessibility are crucial to further reducing maternal mortality in Nepal.

Keywords: Sexual and Reproductive Health and Rights

See extended abstract.