Social capital as a key determinant of willingness to join community-based health insurance: a household survey in Nepal.

OBJECTIVES: Although community-based health insurance (CBHI) schemes have been considered as an intermediate stage to achieve universal health coverage (UHC) in low-resource settings, there is a knowledge gap on ways to make it better. STUDY DESIGN: More than 4000 Nepalese households were randomly selected and surveyed. METHODS: Logistic and multivariate multinomial regressions were estimated. RESULTS: Overall, 88% of included household heads were willing to join CBHI, 61% were willing to pay annual premium less than 600 Nepalese rupees (US$5.6) per household, and more than a half (53%) responded that the government should subsidize a significant portion of the premium. Results showed that a higher level of social capital was significantly related with an increase in odds of accepting higher premiums, while individuals' health status and age did not have such associations. Individuals with bonding social capital were more likely to be inclined to join CBHI. Persons who said they can lend money for a living expense (bonding capital) did not want the government to subsidize the scheme, while this negative association would be reversed if persons had both bonding and bridging social capitals. CONCLUSION: We found significantly positive relationships between social capital and willingness to join and willingness to pay for CBHI in Nepal. Policymakers, aiming to achieve UHC, should be advised that bonding and bridging social capital have differing relationships with willingness to cooperate the external funding sources.