Work in Progress
I evaluate the health care utilization of National Health Insurance Program (NHIP) in Nepal exploiting the staggered rollout.
Expanding access to health insurance is a major policy priority in low- and middle-income countries, yet rigorous evidence on its effects remains limited. This paper examines the impact of Nepal’s National Health Insurance Program (NHIP), a government-led scheme rolled out gradually across all 77 districts between 2016 and 2022. I exploit this staggered rollout as a natural experiment and apply the Callaway and Sant’Anna (2021) difference-in-differences estimator to estimate causal effects while accounting for treatment effect heterogeneity. Using a unique administrative dataset with monthly district-level health records from 2014 to 2022, I provide new evidence on how public health insurance influences health care utilization and equity in access. The results show that health insurance eligibility significantly increases health service use: total visits rise by 13 percent, new visits by 10 percent, and emergency visits by 18 percent. Insurance also increases the use of laboratory services by nearly 96 percent and radiographic services by 17 percent. Dynamic effects suggest a gradual uptake, with significant impacts emerging only after five quarters of implementation. However, the benefits are not evenly distributed. Utilization gains are larger among older populations and in richer districts, while poorer districts experience little measurable effect. Gender disparities are also evident: although female visits increase in absolute terms, the share of female visits declines, implying that men benefit more from the program. Taken together, these findings highlight both the promise and the limitations of public health insurance in a lower-middle-income country context. Nepal’s NHIP expanded overall access to healthcare, but its benefits accrued disproportionately to men and residents of better-off districts. The results underscore the importance of complementary policies such as targeted outreach and financial support to ensure that health insurance achieves its equity goals alongside its utilization gains.