Factors Associated with Enrolment in the National Health Insurance Program among Community People in an Urban Municipality

Background Enrollment in health insurance programs is pivotal for improving healthcare access and providing financial risk protection. Nepal’s National Health Insurance Program (NHIP) was launched on 8 April 2016 in Kailali district to advance universal health coverage. Despite a government target of 100% population coverage, NHIP enrollment remains low—18.9% nationally and 8.0% in Sudurpaschim province. This study aimed to identify factors associated with household enrollment in the NHIP in an urban municipality of Sudurpaschim province. Methods We conducted a cross-sectional comparative study in Bheemdatta Municipality Ward 6 between January and March 2024. A total of 252 households (126 enrolled; 126 non-enrolled) were selected via stratified random sampling. Data were collected through face-to-face interviews using a structured questionnaire covering sociodemographic characteristics, healthcare utilization, perceived health status, presence of chronic illness, and program perceptions. Logistic regression analyses were performed in SPSS v26 to estimate odds ratios (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CI). Statistical significance was set at p < 0.05. Results Compared to nuclear families, joint families were less likely to enroll in the NHIP (AOR 0.42; 95% CI: – ). Households with three or more members having completed secondary education had lower odds of enrollment (AOR 0.42; 95% CI: – ), as did those reporting ≥ 10 health facility visits in the past year (AOR 0.43; 95% CI: – ) and families perceiving good health status (AOR 0.29; 95% CI: – ). In contrast, households with a family member suffering chronic illness (AOR 2.66; 95% CI: – ), those not seeking treatment at private facilities (AOR 5.29; 95% CI: – ), and those holding a positive perception of the NHIP (AOR 6.28; 95% CI: – ) were significantly more likely to enroll. Conclusions Family structure, educational attainment, healthcare utilization patterns, perceived health status, chronic illness presence, and program perceptions significantly influence NHIP enrollment. Tailored interventions addressing these determinants could enhance NHIP uptake and support Nepal’s universal health coverage objectives.