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Nepal’s National Health Insurance Program (NHIP), started in 2016, set out to improve access to healthcare and protect citizens from high medical costs. However, the program has struggled with low enrollment and high dropout rates. A recent study by CUNY SPH doctoral graduate Rajani Bharati explored why this is happening and what effects the program has had so far.
Dr. Bharati and team, including Professor Diana Romero, Clinical Professor James Sherry, and former faculty member Alexis Pozen, found that both people who joined and those who didn’t saw the quality of health services as a key factor in their decisions. Other important issues included lack of awareness about the insurance, delays in starting coverage after registration, complicated referral rules, and difficulties reaching health facilities. Many also cited trouble affording premiums and doubts about whether insurance would be useful for them.
Health workers reported that NHIP increased the number of patients and administrative tasks, but resources and support did not keep up. They faced challenges like slow reimbursements, complicated medicine procurement, and not enough information about how the insurance works.
Despite these challenges, the study’s quantitative data showed that NHIP led to more patient visits and referrals in districts where it was implemented, even when only 5% of people enrolled. This suggests the program can increase healthcare use, but its success depends heavily on the quality and accessibility of the health system overall.
“To make NHIP more effective, we recommend raising public awareness, simplifying the insurance process, improving access to health facilities, and ensuring enough resources and staff,” says Bharati. “Addressing these issues is crucial for Nepal to move closer to universal health coverage.”
