Survey-weighted cross-sectional study links Nepal insurance enrollment with higher curative healthcare use

A survey-weighted cross-sectional study in Suryabinayak municipality, Nepal, found that households enrolled in the National Health Insurance Program reported more use of several healthcare services than uninsured households, while preventive service use showed no overall association. The available abstract reports overall utilization of 74.7% among insured households and 53.6% among uninsured households, a statistically significant difference. In adjusted analyses, enrollment was associated with higher odds of overall, outpatient, diagnostic, emergency and inpatient service use, but not preventive services overall.

Researchers conducted a community-based comparative cross-sectional survey from June to July 2025. They randomly selected five of Suryabinayak’s 10 administrative wards, then used two-stage stratified random sampling to recruit 301 households in Bhaktapur: 150 with National Health Insurance Program enrollment and 151 without it. Utilization outcomes covered overall service use, outpatient visits, diagnostic services, emergency care, inpatient admissions and preventive services during the preceding six months. The analysis used survey-weighted multivariable logistic regression, with potential confounders identified through a directed acyclic graph. The authors also assessed robustness using Firth’s penalized regression, inverse-probability-of-treatment weighting and sensitivity analyses.

After adjustment, insurance enrollment was associated with higher odds of overall healthcare utilization (adjusted odds ratio, aOR, 2.69; 95% confidence interval, 1.56–4.63). The abstract also reports associations with outpatient use (aOR 2.13), diagnostic services (aOR 2.57), emergency care (aOR 2.81) and hospital admission (aOR 2.21), and says these findings were consistent across the sensitivity analyses. Preventive service use did not differ significantly between insured and uninsured households in the unadjusted comparison (p=0.617), and enrollment was not associated with preventive use overall (aOR 1.37). That association varied by socioeconomic status: it was positive among wealthier households (aOR 3.40) but absent among poorer households (aOR 0.40).

Concentration-index analysis found pro-rich inequality in healthcare utilization. The abstract reports that National Health Insurance Program enrollment reduced this inequality for curative services, but not for preventive care or hospital admission. Chronic illness (aOR 3.90) and higher socioeconomic status (aOR 3.39) were the strongest independent predictors of overall utilization. As a cross-sectional study in one municipality, the research cannot establish that insurance enrollment caused the reported differences or determine their temporal ordering. The abstract does not provide the full study methods, including additional potential limitations, so the findings are limited to the reported survey population and service-specific associations. The authors concluded that the results support attention to socioeconomic differences in preventive-care access alongside the observed associations with curative and diagnostic utilization.

Subject of Research: Association between Nepal’s National Health Insurance Program and service-specific household healthcare utilization

Article Title: Health insurance and differential healthcare utilization in Suryabinayak municipality, Nepal: a survey-weighted analysis using Andersen’s Behavioral Model

Article References: Bhattarai, G., Bhandari, N., Niroula, S., Wagle, S., Khanal, P., & Poudyal, A. K. (2026). Health insurance and differential healthcare utilization in Suryabinayak municipality, Nepal: a survey-weighted analysis using Andersen’s Behavioral Model. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15654-0

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DOI: 10.1186/s12913-026-15654-0

Keywords: National Health Insurance Program, Nepal, healthcare utilization, preventive services, health equity, cross-sectional survey, Suryabinayak municipality, survey weighting, Health, insurance, differential, healthcare