A total of 225 insured and 225 uninsured households having 1242 and 1218 members were included in the study. Uni-variate analysis was described on the basis of insurance enrollment status. According to objective bi-variate analysis was done based on service utilization and OOP expenditure among insurance status.
Table 1. Descriptive analysis of households characteristics
Characteristics
|
Insured n (%)
|
Uninsured n (%)
|
p Value
|
Age in years
|
≤ 30
|
6 (2.7)
|
13 (5.8)
|
0.511
|
31-45
|
61 (27.1)
|
58 (25.8)
|
|
46-60
|
92 (40.9)
|
84 (37.3)
|
|
61-75
|
56 (24.9)
|
61 (27.1)
|
|
≥ 76
|
10 (4.4)
|
9 (4)
|
|
Sex
|
|
|
|
Male
|
167 (74.2)
|
154 (68.4)
|
0.175
|
Female
|
58 (25.8)
|
71 (31.6)
|
|
Religion
|
|
|
|
Hindu
|
175 (77.8)
|
198 (88)
|
0.009
|
Buddhist
|
36 (16)
|
18 (8)
|
|
Christian
|
8 (3.6)
|
8 (3.6)
|
|
Islam
|
6 (2.7)
|
1 (0.4)
|
|
Ethnicity
|
|
|
|
Dalit
|
27 (12)
|
44 (19.6)
|
<0.001
|
Janajati
|
66 (29.3)
|
40 (17.8)
|
|
Muslim
|
8 (3.6))
|
0 (0)
|
|
Brahamn/Chhetri
|
124 (55.1)
|
141 (62.7)
|
|
Education
|
|
|
|
Illiterate
|
37 (16.4)
|
38 (16.9)
|
0.320
|
Literate
|
38 (16.9)
|
49 (21.8)
|
|
Basic
|
54 (24)
|
63 (28)
|
|
Secondary
|
72 (32)
|
57 (25.3)
|
|
Higher
|
24 (10.7)
|
18 (8)
|
|
Number of family member
|
|
|
≤ 5
|
129 (57.3)
|
136 (60.4)
|
0.502
|
≥ 6
|
96 (42.7)
|
89 (39.6)
|
|
Occupation
|
|
|
|
Agriculture/Labor
|
74 (32.9)
|
111 (49.3)
|
0.003
|
Business
|
49 (21.8)
|
33 (14.7)
|
|
Foreign employment
|
46 (20.4)
|
30 (13.3)
|
|
Service
|
56 (24.9)
|
51 (22.7)
|
|
Wealth Status
|
|
|
|
Lowest quintile
|
12 (5.3)
|
17 (7.6)
|
0.025
|
First quintile
|
18 (8)
|
28 (12.4)
|
|
Second quintile
|
57 (25.3)
|
68 (30.2)
|
|
Third quintile
|
59 (26.2)
|
63 (28)
|
|
Highest quintile
|
79 (35.1)
|
49 (21.8)
|
|
Chronic disease/disability
|
|
|
|
Yes
|
108 (48)
|
96 (42.7)
|
0.256
|
No
|
117 (52)
|
129 (57.3)
|
|
Perceived health status
|
|
|
|
Good
|
38 (16.9)
|
41 (18.2)
|
0.597
|
Average
|
183 (81.3)
|
177 (78.7)
|
|
Bad
|
4 (1.8)
|
7 (3.1)
|
|
Health system preferred
|
|
|
Allopathic
|
206 (91.6)
|
199 (88.4)
|
0.422
|
Traditional healer
|
15 (6.7)
|
18 (8)
|
|
Ayurveda
|
4 (1.8)
|
8 (3.6)
|
|
Time to reach HF
|
|
|
|
<30
|
106 (47.1)
|
124 (55.1)
|
0.017
|
30-60
|
87 (38.7)
|
59 (26.2)
|
|
>60
|
32 (14.2)
|
42 (18.7)
|
|
Basic Characteristics of Households
Majority of households were headed by male, which was almost similar among both insured (74.2%) and uninsured (68.4%) households. There was a significant difference in religion of insured and uninsured households; p = 0.009. Similarly, ethnicity also found significantly different among the both insured and uninsured group; p <0.001. Occupation p = 0.003, wealth status p = 0.025 and time to reach health facility p = 0.017 were found significantly different among the insured and uninsured households. Most of independent variables like age, education, number of family member, health system preferred, chronic disease/disability and perceived health status were not found significantly different among both insured and uninsured group.
Table 2. Associated factors with health service utilization
Characteristics
|
Health service utilization
|
Yes
|
No
|
OR (95% CI)
|
P value
|
Insurance Status
|
|
|
|
|
Insured
|
186 (82.70 %)
|
39 (17.30 %)
|
1.774 (1.127 – 2.791 )
|
0.013*
|
Uninsured
|
164 (72.90 %)
|
61(27.11 %)
|
Reference
|
|
Religion
|
|
|
|
|
Hindu
|
289 (77.50%)
|
84 (22.50%)
|
0.902 (0.494–1.647)
|
0.738
|
Non-Hindu
|
61 (79.20%)
|
16 (20.80%)
|
Reference
|
|
Ethnicity
|
|
|
|
|
Non-Dalit
|
305 (80.5 0%)
|
74 (19.50 %)
|
2.381 (1.380 – 4.109)
|
0.002**
|
Dalit
|
45 (63.40%)
|
26 (36.60 %)
|
Reference
|
|
Number of Family
|
|
|
|
|
≤5 members
|
204 (77.00%)
|
61 (23.00%)
|
1.119 (0.711-1.764)
|
0.627
|
>5 members
|
146 (78.90%)
|
39 (21.10%)
|
Reference
|
|
Education
|
|
|
|
|
Literate
|
296 (78.90%)
|
79 (21.10%)
|
1.457 (0.831-2.556)
|
0.189
|
Illiterate
|
54 (72.00%)
|
21 (28.00)
|
Reference
|
|
Occupation
|
|
|
|
|
Non-agriculture
|
224 (84.50 %)
|
4 1(15.50 %)
|
2.731 (1.376 – 5.424)
|
0.004**
|
Agriculture
|
126 (68.1 0%)
|
59 (31.90%)
|
Reference
|
|
Wealth Index
|
|
|
|
|
IVth & richest quintile
|
214 (85.60%)
|
36 (14.40 %)
|
2.468 (1.341 – 4.540)
|
0.004**
|
Middle quintile
|
83 (66.40%)
|
42 (33.60%)
|
0.820 (0.441 – 1.525)
|
0.531
|
Poorest & IInd quintile
|
53 (70.60 %)
|
22 (29.50%)
|
Reference
|
|
Perceived Health Status of Family
|
|
|
|
Good
|
65 (82.30%)
|
14 (17.70 %)
|
8.125 (2.091 – 31.576)
|
0.002**
|
Average
|
281 (78.00%)
|
79 (22 .00%)
|
6.225 (1.777 – 21.804)
|
0.004 **
|
Bad
|
4 (36.4 0%)
|
7 (63.60%)
|
Reference
|
|
Chronic health problem/ Disability in the family
|
|
|
Present
|
163 (79.90%)
|
41 (20.10%)
|
1.254 (0.799-1.968)
|
0.324
|
Absent
|
187 (76.00%)
|
59 (24.00%)
|
Reference
|
|
Time to reach commonly used health facility
|
|
|
<30 minutes
|
174 (75.70%)
|
56 (24.30%)
|
0.857 (0.456-1.610)
|
0.632
|
30-60 minutes
|
118 (80.80%)
|
28 (19.20%)
|
1.163 (0.583-2.318)
|
0.669
|
>60 minutes
|
58 (78.40%)
|
16 (21.60%)
|
Reference
|
|
Health system preferred
|
|
|
|
Allopathic
|
324 (80 .00%)
|
81 (20.00%)
|
2.857 (0.884 – 9.235)
|
0.079
|
Non-allopathic
|
26 (57.8 0%)
|
19 (42.20%)
|
Reference
|
|
Odd Ratio(OR) and p value based on binary logistic regression, * p value significant at <0.05, ** p value significant at <0.01.
Health Service Utilization
The overall health service utilization was found 77.8 %. When health service utilization was compared with the insurance status, it was found 82.7 % and 72.9 % among insured and uninsured households respectively. Insured households were 1.774 (95 % CI = 1.127 – 2.791) times more likely to utilize health services in compared to uninsured households; p = 0.013. Similarly, among overall households beside insurance status ethnicity, occupation, wealth index and perceived health status of the family were found major predictor of health service utilization.
Table 3. Associated factors with out-of-pocket health expenditure
Variables and it’s category
|
Median OOP (IQR) in NRS
|
MW-U value
|
p value
|
Insurance status
|
|
|
|
Insured
|
200 (1550)
|
17988.50
|
<0.001***
|
Uninsured
|
1225 (5175)
|
|
|
Religion
|
|
|
|
Hindu
|
700 (3620)
|
13362.50
|
0.328
|
Non-Hindu
|
500 (2250)
|
|
|
Ethnicity
|
|
|
|
Dalit
|
1275 (5300)
|
11899.50
|
0.115
|
Non-Dalit
|
600 (2800)
|
|
|
Educational status
|
|
|
|
Illiterate
|
700 (5000)
|
13932
|
0.897
|
Literate
|
610 (2500)
|
|
|
Occupation
|
|
|
|
Agriculture
|
805 (4000)
|
21294
|
0.016*
|
Others
|
400 (2500)
|
|
|
Wealth status
|
|
|
Up to middle quintile
|
720 (3791)
|
24013
|
0.463
|
Fourth & richest quintile
|
500 (2575)
|
|
|
Time to reach health Facility
|
≤60minutes
|
8617 (3000)
|
13283
|
0.531
|
>60 minutes
|
700 (4272)
|
|
|
|
|
|
|
|
P value based on Mann-Whitney U (MW-U) test, * p value significant at <0.05, ** p value significant at <0.001.
Out of Pocket Health Expenditure
For measuring association between OOP health expenditure with insurance status and another covariate we perform Mann Whitney U test. Considering one-month preceding period for OOP; among insured households the median OOP health expenditure was found NRS 200 (IQR = 1550) and among uninsured households it was NRS 1225 (IQR = 5175). Among uninsured households median OOP was more than six times higher compared to insured households which was highly significant (p <0.001). Beside insurance status occupation was also found statistically significant with OOP; p = 0.016.