Nepal’s National Health Insurance Program (NHIP), launched in 2016 to improve healthcare access and reduce costs, has faced low enrollment and high dropout rates due to concerns about service quality, lack of awareness, administrative delays, and affordability issues. Despite these challenges, the program has increased healthcare utilization in participating districts and improved health system resources to achieve its goals.
Nepal’s National Health Insurance Program (NHIP), launched in 2016 to advance universal health coverage and reduce out-of-pocket healthcare costs, has struggled with persistent challenges. Despite its aim to improve healthcare access and financial protection, the program faces low enrollment and high dropout rates. A study led by Rajani Bharati and colleagues explored the reasons behind these issues and assessed the program’s impact.
Both those who enrolled and those who did not identified the quality of health services as a decisive factor in their participation. Other significant barriers included a lack of awareness about the insurance scheme, delays in coverage activation following registration, complicated referral processes, and difficulties accessing health facilities, particularly in remote areas. Many respondents also highlighted the unaffordability of premiums and uncertainty about the insurance’s usefulness for their needs.
On the supply side, health workers reported that NHIP increased patient numbers and administrative burdens, but additional resources and support did not keep pace. They faced slow reimbursements, complex medicine procurement processes, and insufficient information about the insurance system, all of which hampered effective implementation1.
Despite these operational and systemic challenges, quantitative data from the study showed that NHIP led to increased patient visits and referrals in districts where it was implemented, even when enrollment rates were as low as 5%. This suggests the program has the potential to boost healthcare utilization, but its effectiveness is closely tied to the overall quality and accessibility of the health system.
The study concludes that for NHIP to fulfill its promise, efforts must focus on raising public awareness, simplifying insurance processes, improving access to health facilities, and ensuring adequate resources and staffing. Addressing these issues is essential for Nepal to make progress toward universal health coverage and to ensure that health insurance delivers meaningful benefits to its citizens.
