{"id":"https://openalex.org/W7214950669","doi":"https://doi.org/10.64898/2026.09.29.26364291","title":"Health Insurance and Maternal Healthcare Utilisation in Nepal: Evidence from the Nepal Demographic and Health Survey 2022","display_name":"Health Insurance and Maternal Healthcare Utilisation in Nepal: Evidence from the Nepal Demographic and Health Survey 2022","publication_year":2026,"publication_date":"2026-09-30","ids":{"openalex":"https://openalex.org/W7214950669","doi":"https://doi.org/10.64898/2026.09.29.26364291"},"language":"en","primary_location":{"id":"doi:10.64898/2026.09.29.26364291","doi":"https://doi.org/10.64898/2026.09.29.26364291","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.29.26364291","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/30/2026.09.29.26364291.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/30/2026.09.29.26364291.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5020598688","display_name":"Yash Raj Lamsal","orcid":"https://orcid.org/0000-0001-6151-1216","observed_orcids":["https://orcid.org/0000-0001-6151-1216"]},"institutions":[{"id":"https://openalex.org/I47881588","display_name":"Kathmandu University","ror":"https://ror.org/036xnae80","country_code":"NP","type":"education","lineage":["https://openalex.org/I47881588"]}],"countries":["NP"],"is_corresponding":true,"raw_author_name":"Yash Raj Lamsal","raw_affiliation_strings":["Department of Management Informatics and Communication, Kathmandu University, Nepal"],"raw_orcid":"https://orcid.org/0000-0001-6151-1216","affiliations":[{"raw_affiliation_string":"Department of Management Informatics and Communication, Kathmandu University, Nepal","institution_ids":["https://openalex.org/I47881588"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5092171709","display_name":"Abdulaziz Mohammed Hussen","orcid":"https://orcid.org/0000-0003-1609-8498","observed_orcids":["https://orcid.org/0000-0003-1609-8498"]},"institutions":[{"id":"https://openalex.org/I193662353","display_name":"Utrecht University","ror":"https://ror.org/04pp8hn57","country_code":"NL","type":"education","lineage":["https://openalex.org/I193662353"]},{"id":"https://openalex.org/I3018483916","display_name":"University Medical Center Utrecht","ror":"https://ror.org/0575yy874","country_code":"NL","type":"healthcare","lineage":["https://openalex.org/I3018483916"]},{"id":"https://openalex.org/I4210100457","display_name":"Samara University","ror":"https://ror.org/013fn6665","country_code":"ET","type":"education","lineage":["https://openalex.org/I4210100457"]},{"id":"https://openalex.org/I8764889","display_name":"University of Gondar","ror":"https://ror.org/0595gz585","country_code":"ET","type":"education","lineage":["https://openalex.org/I8764889"]}],"countries":["ET","NL"],"is_corresponding":false,"raw_author_name":"Abdulaziz Mohammed Hussen","raw_affiliation_strings":["Center for Digital Health and Implementation Sciences (CDHI), University of Gondar, Gondar, Ethiopia","Department of Global Public Health & Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands","Department of Midwifery, College of Medicine and Health Science, Samara University, Samara, Ethiopia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Center for Digital Health and Implementation Sciences (CDHI), University of Gondar, Gondar, Ethiopia","institution_ids":["https://openalex.org/I8764889"]},{"raw_affiliation_string":"Department of Global Public Health & Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands","institution_ids":["https://openalex.org/I193662353","https://openalex.org/I3018483916"]},{"raw_affiliation_string":"Department of Midwifery, College of Medicine and Health Science, Samara University, Samara, Ethiopia","institution_ids":["https://openalex.org/I4210100457"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5056142815","display_name":"Joyce Linda Browne","orcid":"https://orcid.org/0000-0001-7048-3245","observed_orcids":["https://orcid.org/0000-0001-7048-3245"]},"institutions":[{"id":"https://openalex.org/I193662353","display_name":"Utrecht University","ror":"https://ror.org/04pp8hn57","country_code":"NL","type":"education","lineage":["https://openalex.org/I193662353"]},{"id":"https://openalex.org/I3018483916","display_name":"University Medical Center Utrecht","ror":"https://ror.org/0575yy874","country_code":"NL","type":"healthcare","lineage":["https://openalex.org/I3018483916"]}],"countries":["NL"],"is_corresponding":false,"raw_author_name":"Joyce L. Browne","raw_affiliation_strings":["Department of Global Public Health & Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Global Public Health & Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands","institution_ids":["https://openalex.org/I193662353","https://openalex.org/I3018483916"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5010536719","display_name":"Reshu Agrawal Sagtani","orcid":"https://orcid.org/0000-0002-0312-2690","observed_orcids":["https://orcid.org/0000-0002-0312-2690"]},"institutions":[{"id":"https://openalex.org/I1330522730","display_name":"Patan Academy of Health Sciences","ror":"https://ror.org/02mphcg88","country_code":"NP","type":"education","lineage":["https://openalex.org/I1330522730"]}],"countries":["NP"],"is_corresponding":false,"raw_author_name":"Reshu Agrawal Sagtani","raw_affiliation_strings":["School of Public Health, Patan Academy of Health Sciences, Nepal"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Public Health, Patan Academy of Health Sciences, Nepal","institution_ids":["https://openalex.org/I1330522730"]}]}],"institutions":[],"countries_distinct_count":3,"institutions_distinct_count":6,"corresponding_author_ids":["https://openalex.org/A5020598688"],"corresponding_institution_ids":["https://openalex.org/I47881588"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10209","display_name":"Global Maternal and Child Health","score":0.9208999872207642,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10209","display_name":"Global Maternal and Child Health","score":0.9208999872207642,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11531","display_name":"Healthcare Systems and Reforms","score":0.07620000094175339,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.0008999999845400453,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/health-insurance-coverage","display_name":"health insurance coverage","score":0.9599999785423279},{"id":"https://openalex.org/keywords/maternal-healthcare-utilisation","display_name":"maternal healthcare utilisation","score":0.906000018119812},{"id":"https://openalex.org/keywords/prenatal-care","display_name":"prenatal care","score":0.9879999756813049},{"id":"https://openalex.org/keywords/postnatal-care","display_name":"postpartum care","score":0.8709999918937683},{"id":"https://openalex.org/keywords/skilled-birth-attendance","display_name":"skilled birth attendance","score":0.9290000200271606},{"id":"https://openalex.org/keywords/institutional-delivery","display_name":"institutional delivery","score":0.9980000257492065},{"id":"https://openalex.org/keywords/financial-barriers-to-care","display_name":"financial barriers to care","score":0.7630000114440918},{"id":"https://openalex.org/keywords/maternity-care","display_name":"obstetric care","score":0.4620000123977661},{"id":"https://openalex.org/keywords/nepal","display_name":"Nepal","score":0.671999990940094},{"id":"https://openalex.org/keywords/uninsured-women","display_name":"uninsured women","score":0.550000011920929},{"id":"https://openalex.org/keywords/unmeasured-confounding","display_name":"unmeasured confounding","score":0.734000027179718},{"id":"https://openalex.org/keywords/e-values","display_name":"E-value","score":0.7570000290870667},{"id":"https://openalex.org/keywords/propensity-score-weighting","display_name":"propensity score weighting","score":0.6470000147819519},{"id":"https://openalex.org/keywords/health-policy","display_name":"health policy","score":0.6019999980926514}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.6589000225067139},{"id":"https://openalex.org/C143095724","wikidata":"https://www.wikidata.org/wiki/Q515895","display_name":"Odds","level":3,"score":0.6294999718666077},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.6281999945640564},{"id":"https://openalex.org/C17923572","wikidata":"https://www.wikidata.org/wiki/Q7250160","display_name":"Propensity score matching","level":2,"score":0.5315999984741211},{"id":"https://openalex.org/C2778173179","wikidata":"https://www.wikidata.org/wiki/Q25339289","display_name":"Attendance","level":2,"score":0.5070000290870667},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.47929999232292175},{"id":"https://openalex.org/C147077947","wikidata":"https://www.wikidata.org/wiki/Q1515895","display_name":"Socioeconomic status","level":3,"score":0.4555000066757202},{"id":"https://openalex.org/C2775949068","wikidata":"https://www.wikidata.org/wiki/Q4260475","display_name":"Health facility","level":4,"score":0.39570000767707825},{"id":"https://openalex.org/C2776877085","wikidata":"https://www.wikidata.org/wiki/Q4917007","display_name":"Birth attendant","level":5,"score":0.3871000111103058},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.38499999046325684},{"id":"https://openalex.org/C156957248","wikidata":"https://www.wikidata.org/wiki/Q1862216","display_name":"Odds ratio","level":2,"score":0.357699990272522},{"id":"https://openalex.org/C47344431","wikidata":"https://www.wikidata.org/wiki/Q1519812","display_name":"Health policy","level":3,"score":0.35010001063346863},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.34139999747276306},{"id":"https://openalex.org/C2983635472","wikidata":"https://www.wikidata.org/wiki/Q334911","display_name":"Health insurance","level":3,"score":0.3402000069618225},{"id":"https://openalex.org/C2910910449","wikidata":"https://www.wikidata.org/wiki/Q749115","display_name":"Postnatal Care","level":3,"score":0.33629998564720154},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.32429999113082886},{"id":"https://openalex.org/C2778279030","wikidata":"https://www.wikidata.org/wiki/Q1543380","display_name":"Live birth","level":3,"score":0.3230000138282776},{"id":"https://openalex.org/C2250968","wikidata":"https://www.wikidata.org/wiki/Q1512929","display_name":"Health equity","level":3,"score":0.29260000586509705},{"id":"https://openalex.org/C2983493262","wikidata":"https://www.wikidata.org/wiki/Q6786626","display_name":"Maternal health","level":4,"score":0.28850001096725464},{"id":"https://openalex.org/C189326681","wikidata":"https://www.wikidata.org/wiki/Q10294","display_name":"Poverty","level":2,"score":0.2824999988079071},{"id":"https://openalex.org/C2779234561","wikidata":"https://www.wikidata.org/wiki/Q11995","display_name":"Pregnancy","level":2,"score":0.26980000734329224},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.25839999318122864},{"id":"https://openalex.org/C2779703513","wikidata":"https://www.wikidata.org/wiki/Q34581","display_name":"Childbirth","level":3,"score":0.2556000053882599}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.09.29.26364291","doi":"https://doi.org/10.64898/2026.09.29.26364291","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.29.26364291","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/30/2026.09.29.26364291.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.09.29.26364291","doi":"https://doi.org/10.64898/2026.09.29.26364291","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.29.26364291","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/30/2026.09.29.26364291.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.9940000176429749,"display_name":"Good health and well-being"},{"id":"https://metadata.un.org/sdg/10","score":0.7578999996185303,"display_name":"Reduced inequalities"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7214950669.pdf","grobid_xml":"https://content.openalex.org/works/W7214950669.grobid-xml"},"referenced_works_count":37,"referenced_works":["https://openalex.org/W1990160987","https://openalex.org/W2009187570","https://openalex.org/W2060316606","https://openalex.org/W2110818436","https://openalex.org/W2142495742","https://openalex.org/W2143891888","https://openalex.org/W2168014332","https://openalex.org/W2168639902","https://openalex.org/W2275737843","https://openalex.org/W2321654804","https://openalex.org/W2331936027","https://openalex.org/W2487770199","https://openalex.org/W2528775703","https://openalex.org/W2560568394","https://openalex.org/W2729517813","https://openalex.org/W2735301415","https://openalex.org/W2910632137","https://openalex.org/W3035170547","https://openalex.org/W3090393259","https://openalex.org/W3114319529","https://openalex.org/W3130226260","https://openalex.org/W3159635605","https://openalex.org/W3168924500","https://openalex.org/W3194053188","https://openalex.org/W4210472177","https://openalex.org/W4294553991","https://openalex.org/W4299627282","https://openalex.org/W4317543142","https://openalex.org/W4385484360","https://openalex.org/W4386917989","https://openalex.org/W4393991112","https://openalex.org/W4399647826","https://openalex.org/W4402304797","https://openalex.org/W4407274770","https://openalex.org/W4408836468","https://openalex.org/W4414962552","https://openalex.org/W4416430243"],"related_works":["https://openalex.org/W4307526358","https://openalex.org/W4380434262","https://openalex.org/W3194521628","https://openalex.org/W4210700937","https://openalex.org/W4389484964","https://openalex.org/W4404037933","https://openalex.org/W2942215430","https://openalex.org/W4411687283","https://openalex.org/W3120405068","https://openalex.org/W2806554384"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"Access":[2],"to":[3,22,122,140],"maternal":[4,11,30,149,214,347,358],"healthcare":[5,23,215,317,348],"services":[6,67,318],"is":[7],"essential":[8],"for":[9,163,329],"improving":[10],"and":[12,25,33,41,52,63,82,126,131,148,161,177,195,262,288,315,350,357],"neonatal":[13],"health":[14,31,49,145,192,204,337,355],"outcomes.":[15,152],"Health":[16,83,305],"insurance":[17,50,146,193,205,275,306,338],"can":[18,36],"reduce":[19],"financial":[20],"barriers":[21],"access":[24],"may":[26,344],"facilitate":[27],"utilisation":[28,53,151,212,312,349],"of":[29,54,112,213,225,247,255,313],"services,":[32],"contextualized":[34],"evidence":[35],"further":[37],"support":[38,351],"policy":[39],"development":[40],"implementation.":[42],"This":[43,73],"study":[44,74],"assessed":[45,155],"the":[46,78,104,108,142,181,223],"association":[47,143,326],"between":[48,129,144],"coverage":[51,147,194,206,276,307,356],"antenatal":[55,314],"care":[56,65],"(ANC),":[57],"institutional":[58,281,330],"delivery,":[59],"skilled":[60,267,289,333],"birth":[61,102,176,290,334],"attendance":[62,291],"postnatal":[64,316],"(PNC)":[66],"among":[68,319,341],"women":[69,94,169,218,235,243,320],"in":[70,180,321],"Nepal.":[71,322],"Methods":[72],"used":[75,139],"data":[76],"from":[77,265],"2022":[79],"Nepal":[80],"Demographic":[81],"Survey":[84],"(NDHS),":[85],"a":[86,100,173,249,266],"nationally":[87],"representative":[88],"cross-sectional":[89],"survey.":[90,109],"The":[91],"analysis":[92,182],"included":[93,179],"aged":[95],"15\u201349":[96],"years":[97],"who":[98],"had":[99,191,219,244],"live":[101,175],"within":[103,252],"24":[105],"months":[106],"preceding":[107],"Inverse":[110],"probability":[111],"treatment":[113],"weighting":[114],"(IPTW)":[115],"based":[116],"on":[117],"propensity":[118,158],"scores":[119],"was":[120,154,207,277,308,327],"applied":[121],"balance":[123],"measured":[124],"socioeconomic":[125],"demographic":[127],"characteristics":[128],"insured":[130,242],"uninsured":[132,234],"women.":[133],"Weighted":[134],"marginal":[135],"structural":[136],"models":[137],"were":[138,178,198],"estimate":[141],"health-care":[150],"Robustness":[153],"using":[156,202],"alternative":[157],"score":[159],"specifications":[160],"E-values":[162],"unmeasured":[164],"confounding.":[165],"Results":[166],"Among":[167],"14,845":[168],"interviewed,":[170],"2,078":[171],"reported":[172],"recent":[174],"(unweighted;":[183],"1,998":[184],"when":[185],"survey-weighted).":[186],"Of":[187],"these,":[188],"201":[189],"(9.7%)":[190],"1,877":[196],"(90.3%)":[197],"uninsured.":[199],"After":[200],"adjustment":[201],"IPTW,":[203],"associated":[208,279,309],"with":[209,233,280,310],"significantly":[210],"higher":[211,245],"services.":[216],"Insured":[217],"more":[220],"than":[221],"twice":[222],"odds":[224,246],"attending":[226],"at":[227],"least":[228],"four":[229],"ANC":[230],"visits":[231],"compared":[232],"(AOR":[236,257,269,283,292],"2.14;":[237],"95%":[238,259,271,285,294],"CI":[239,260,272,286,295],"1.15\u20133.98).":[240],"Similarly,":[241],"receiving":[248,263],"PNC":[250,264],"check-up":[251],"two":[253],"days":[254],"delivery":[256,282,331],"2.05;":[258],"1.28\u20133.27)":[261],"provider":[268],"1.94;":[270],"1.23\u20133.06).":[273],"Although":[274],"positively":[278],"1.55;":[284],"0.91\u20132.62)":[287],"1.57;":[293],"0.90\u20132.72),":[296],"these":[297],"associations":[298],"did":[299],"not":[300],"reach":[301],"statistical":[302],"significance.":[303],"Conclusion":[304],"greater":[311],"However,":[323],"no":[324],"significant":[325],"observed":[328],"or":[332],"attendance.":[335],"Expanding":[336],"coverage,":[339],"particularly":[340],"underserved":[342],"populations,":[343],"help":[345],"improve":[346],"progress":[352],"towards":[353],"universal":[354],"health-related":[359],"Sustainable":[360],"Development":[361],"Goals.":[362]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-10-01T00:00:00"}