Social health insurance, family support, and chronic diseases as determinants of health service utilization among senior citizens in rural Nepal

被引：0
作者：
Sujan Poudel [1 ]
Anusha Parajuli [2 ]
Nirmal Duwadi [3 ]
Bal Krishna Bhatta [2 ]
Shishir Paudel [2 ]
Dhurba Khatri [4 ]
Damaru Prasad Paneru [4 ]
Yam Prasad Sharma [5 ]
机构：
[1] HERD International, Lalitpur
[2] Nobel College, Pokhara University, Kathmandu
[3] College of Public Health, University of South Florida, Tampa
[4] Kathmandu Institute of Child Health, Hepali Height, Kathmandu
[5] School of Health and Allied Sciences, Pokhara University, Pokhara
[6] Government of Nepal, Health Office, Gorkha
来源：
BMC Public Health | / 25卷 / 1期
关键词：
Health service utilization; Rural area; Senior citizen; Utilization;
D O I：
10.1186/s12889-025-22693-5
中图分类号：
学科分类号：
摘要：
Background: The increasing trend of senior citizens and their complex healthcare needs demands the improvised provision of healthcare services and strategies to improve health service utilization to ensure health for all. Although health service provision has been prioritized, health service utilization is also a prime aspect that should be addressed to target the chronic needs of senior citizens. This study aims to assess the status of health service utilization and its influencing factors among senior citizens in rural municipalities of the Kaski district, Nepal. Methods: A cross-sectional study was carried out in selected wards of all rural municipalities of Kaski District (Annapurna, Machhapuchre, Madi and Rupa). The study included a sample size of 392 senior citizens. Data were collected using a semi-structured interview schedule based on the Andersen‒Newman behavioral model using the Study on Global Aging and Adult Health (SAGE) questionnaire to assess health service utilization. Data analysis included descriptive statistics to summarize participant characteristics and health service utilization patterns. Additionally, bivariate and multivariable logistic regression analyses were performed to identify key determinants of healthcare utilization, adjusting for potential confounders. All statistical analyses were conducted using Statistical Package for Social Sciences version 20, with a significance threshold set at p < 0.05. Results: More than half (54.6%) of the senior citizens in the study visited healthcare facilities in the 12 months. Health service utilization was significantly associated with awareness of free healthcare services, membership in social health insurance, family support, self–perceived health status, independence in activities of daily living, and having a chronic disease with a p-value less than 0.05 and 95% confidence interval. After controlling for confounders, membership in social health insurance (aOR = 3.85, 95% CI: 2.31–6.40, p < 0.001), family support (aOR = 2.06, 95% CI: 1.01–4.15, p < 0.05), and the presence of chronic disease (aOR = 2.92, 95% CI: 1.70–4.98, p < 0.001) were statistically significant with health service utilization among the senior citizens. Conclusions: Many senior citizens did not utilize the healthcare services. Enrollment in social health insurance, awareness of free health services, family support and presence of chronic conditions were significantly associated with higher health service utilization. This suggests that to increase health service utilization awareness about health, including social health insurance, and fostering a sense of security and well-being is crucial. © The Author(s) 2025.
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  • [1] Okolo Chioma Anthonia I.S., Arowoogun Jeremiah Olawumi, Adeniyi Adekunle Oyeyemi, Omotayo Olufunke: reviewing the impact of health information technology on healthcare management efficiency, Int Med Sci Res J, 4, 4, pp. 420-440, (2024)
  • [2] Rudnicka E., Napierala P., Podfigurna A., Meczekalski B., Smolarczyk R., Grymowicz M., The world health organization (WHO) approach to healthy ageing, Maturitas, 139, pp. 6-11, (2020)
  • [3] Perez F.P., Perez C.A., Chumbiauca M.N., Insights into the social determinants of health in older adults, J Biomed Sci Eng, 15, 11, (2022)
  • [4] Number of People Over. 60 Years Set to Double by 2050
  • [5] Shrestha S., Aro A.R., Shrestha B., Thapa S., Elderly care in Nepal: are existing health and community support systems enough, SAGE Open Med, 9, (2021)
  • [6] Neupane S.P., Equity in health care in Nepal, Lancet, 384, 9951, pp. 1346-1347, (2014)
  • [7] Liu L., Sun R., Gu Y., Ho K.C., The Effect of China’s Health Insurance on the Labor Supply of Middle-aged and Elderly Farmers, Int J Environ Res Public Health, 17, 18, (2020)
  • [8] Mishra S.R., Khanal P., Karki D.K., Kallestrup P., Enemark U., National health insurance policy in Nepal: challenges for implementation, Glob Health Action, 8, (2015)
  • [9] Senior Citizens Act, 2063, Nepal Law Comission G., (2006)
  • [10] Stojisavljevic S., Dikanovic B., Voncina L., Scott K., Shroff Z., Manigoda D., Strbac S., Bosancic B., Mathauer I., The challenge of ensuring elderly people can access their health insurance entitlements: a mixed methods study on the Republic of Srpska’s protector of patients’ health insurance entitlements, BMJ Global Health, 7, (2022)
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