Impact of National health insurance on medication adherence among hypertensive patients: A hospital-based cross-sectional study from Kailali, Nepal

Nripa Raj Dangaura, Pratik Khanal, Bihari Sharan Kuikel, Sabina Marasini, Ashish Timilsina, Prakash Chandra Joshi, Roshan Mahato, Archana Shrestha and Biraj Man Karmacharya

PLOS ONE, 2025, vol. 20, issue 9, 1-12

Abstract: Introduction: Noncompliance of medication among patients with chronic disease is a major challenge for the health system. Expanding of national health insurance among patients might increase their access to health care services, reduce out of pocket expenditures, and improve health outcomes. This study aimed to determine the association between enrollment in health insurance and medication adherence among hypertensive patients in Nepal. Methods: A cross-sectional study was conducted among 402 patients visiting the outpatient department of Tikapur Hospital located in Kailali, Nepal. Data was collected by face-to-face interviews using a structured questionnaire. Adherence to hypertensive medication was assessed using the Hill Bone Medication Adherence Scale (HB-MAS). A multivariable logistic regression model was constructed to ascertain the association between enrollment in health insurance and medication adherence. Results: Overall, 52.7% (60.2% of uninsured and 45.3% of insured) of the patients was medication adherence. Enrollment in health insurance was not significantly associated with medication adherence. The participants among those who had reported more than secondary level education was higher odds of medication adherence (AOR = 3.30; 95% CI: 1.25–8.73); those who reported more than five minutes of interaction with doctors (AOR = 2.97; 95% CI: 1.56–5.65); those on medication for more than 10 years had higher odds of adherence (AOR:2.56; 95% CI:1.35-4.86); aged group 50-59 years was lower odds of medicatio n (AOR = 0.46; 95% CI: 0.23-0.91); compared to patients with no formal education;those who reported less than or equal to 5 minutes of interaction with doctors; those who had less than 5 years of medication; participants younger than 50 years respectively. Conclusion: Our study showed that enrollment in health insurance was not associated with medication adherence among patients with hypertension. Health system interventions such as improving counseling, patient education, and follow-up, and ensuring availability of medicines might improve medication adherence among patients. Health professionals also should set up education, and interventions aimed at increased awareness of the consequences of non-adherence to antihypertensive medication.

Date: 2025
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DOI: 10.1371/journal.pone.0332602

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