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 voluntary public health insurance program. I exploit its staggered rollout as a natural experiment and use a difference-in-differences strategy to estimate causal effects of NHIP eligibility using novel administrative data. My estimates show that health insurance eligibility significantly increases health service use: total visits rise by 13 percent, outpatient visits by 12 percent, and emergency visits by 18 percent. Insurance eligibility nearly doubles the use of diagnostic services like laboratory and radiographic services. Dynamic effects suggest 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 effects are modest: both male and female visits increase substantially, with only a small relative shift toward male patients. Taken together, these findings highlight both the promise and the limitations of public health insurance in a lower-middle-income country context.