Factors Affecting Health Insurance Utilization among Insured Population: Evidence from Health Insurance Program of Bhaktapur District of Nepal

Background: The Government of Nepal introduced the family-based health insurance program in 2016 to increase financial protection and improve access to health care services. The aim of the study was to assess factors associated with the utilization of health insurance among insured population in an urban district of Nepal. Methods A cross-sectional survey using face-to-face interviews was conducted in 224 households of Bhaktapur district of Nepal. Household heads were interviewed using a structured questionnaire. Logistic regression with weighted analysis was done to identify predictors of service utilization among the insured residents. Results The prevalence of health insurance service utilization at the household level in the Bhaktapur district was 77.2% (n = 224). The number of elder members in the family (AOR 2.7, 95% CI 1.09–7.07), having family member with chronic illness (AOR 5.10, 95% CI 1.48–17.56), willingness to continue health insurance (AOR 2.18, 95% CI 1.47–3.25) and membership duration (AOR 1.14, 95% CI 1.05–1.24) were significantly associated with the utilization of the health insurance at the household level. Conclusion The study identified a particular group of the population who were more likely to utilize health insurance services, including the chronically ill and elderly. Health insurance program in Nepal would benefit from strategies to increase population coverage in health insurance, improve quality of health services, and retain members in the program.