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Spending Beyond Its Means: The Fiscal Sustainability of Nepal’s National Health Insurance Program

with Mukesh Adhikari, Prashant Bhandari, and Suresh Singh Tinkari

Under review at Health Policy and Planning · First author

Using the universe of Nepal's national insurance claims, we show that the programme pays out several times what members contribute, and that the resulting financing gap reaches the front line through lengthening reimbursement delays.

Design
Descriptive analysis of programme administrative records
Data
NHIP membership, premium, and claims records, 2016/17 to 2024/25
Setting
Nepal

Overview

Many low- and middle-income countries seek to finance universal health coverage through voluntary, premium-funded health insurance. This paper asks whether that model is fiscally sustainable in settings where most workers are informal, enrolment is difficult to mandate, and uptake remains limited. Using administrative data from Nepal’s National Health Insurance Program, we examine how membership growth, claims, and premium revenue have evolved since the scheme launched in 2016, and how the resulting financing gap is transmitted to the facilities that deliver care through lengthening reimbursement delays. We conclude that the binding constraint is not enrolment or claims administration but the source of financing itself, and that durable coverage points toward general-revenue financing rather than higher voluntary premiums.

Status

This paper is under review at Health Policy and Planning. The manuscript is not publicly available while it is under double-blind peer review. A draft is available on request: sabin.subedi@strath.ac.uk.