Nepal's Health Insurance Initiative: Challenges and Early Outcomes

Nepal's National Health Insurance Program (NHIP), launched in 2016, aimed to enhance healthcare accessibility and shield citizens from exorbitant medical expenses. Despite these noble goals, the program has faced hurdles such as low enrollment figures and significant dropout rates. A recent comprehensive study conducted by CUNY School of Public Health doctoral graduate Rajani Bharati delves into the underlying reasons behind these challenges and examines the initial impacts of the initiative.

The research highlights that individuals' perceptions of healthcare quality significantly influence their decisions to join or avoid the insurance scheme. Key barriers identified include limited awareness about the insurance, delays in coverage activation post-registration, complex referral procedures, and difficulties accessing healthcare facilities. Additionally, many potential enrollees expressed concerns about affording premiums and questioned the utility of insurance for their needs.

Health workers reported that while NHIP led to increased patient visits and referrals, it also added to administrative burdens. However, resources such as reimbursements, medicine procurement processes, and informational support did not scale proportionally, hampering effective implementation. Despite these obstacles, data from the study indicates that even with approximately 5% enrollment, districts implementing NHIP experienced higher patient turnout and referral rates. This suggests that the program can positively influence healthcare utilization, provided the overall health system's quality and accessibility are sufficient.

To optimize NHIP's effectiveness, experts recommend enhancing public awareness campaigns, streamlining administrative procedures, improving access to health facilities, and ensuring adequate resource allocation and staffing. Such measures are vital for guiding Nepal closer toward achieving universal health coverage.

Source: https://medicalxpress.com/news/2025-06-nepal-health-early-impacts.html