Healthcare provider's experience and attitude towards the national health insurance program of Nepal


  • Mr. Ganesh Graduate Student in Master of Public Health, Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
  • Mr. Jukkrit Faculty of Public Health, Chiang Mai University
  • Noppcha Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand



Healthcare Provider, Experience, Attitude, National Health Insurance Program, Universal Health Coverage


Background: Universal Health Coverage (UHC) aims for accessible quality healthcare for all, without financial strain. Nepal's National Health Insurance Program (NHIP), launched in 2016, strives towards this goal by offering extensive healthcare services and financial protection against severe health costs. However, the NHIP encounters challenges, particularly with reimbursement processes and operational efficiency, which may impact its effectiveness and long-term viability.

Objectives: This study analyzed the situation regarding the experience, attitude, and recommendations of government and non-government Health Care Providers (HCPs) regarding the NHIP.

Methods: This Qualitative study carried out a qualitative analysis via in-depth interviews with 12 HCPs across three Nepalese provinces, assessing their experiences with the NHIP. Our method involved a culturally validated interview guide with 21 detailed questions. Interviews, conducted in Nepali, were translated and analysed through open coding to highlight key themes related to the NHIP's effectiveness and challenges.

Results: Aiming to assess the NHIP's service delivery impact, this study selected participants involved in the NHIP and analysed interview data to uncover themes concerning the NHIP's benefit package, the Insurance Management Information System (IMIS), coordination, and claim and reimbursement processes. The study revealed that the healthcare providers recognized the NHIP's benefits in increasing healthcare access and reducing financial burdens in Nepal yet point out limitations in covering complex diseases and financial sustainability for healthcare facilities. Key challenges include technical issues with IMIS and insufficient support from the Health Insurance Board [HIB].

Conclusion:  Recommendations for enhancing the NHIP involve speeding up reimbursement, improving IMIS functionality, better coordination with the HIB, and revising the benefit package. Despite progress, significant hurdles in implementation and efficiency persist. Addressing these issues requires a multifaceted approach, including technological upgrades, policy adjustments, and enhanced training for healthcare workers. Optimizing the NHIP is essential for Nepal to achieve its UHC goals, ensuring equitable, accessible, and quality healthcare for all its citizens.


Ranabhat CL, Acharya SP, Adhikari C, Kim CB. Universal health coverage evolution, ongoing trend, and future challenge: A conceptual and historical policy review. Frontiers in public health. 2023;11:1041459.

World Health Organization. Progress towards UHC 2022: WHO; 2022 [Available from:

Erlangga D, Suhrcke M, Ali S, Bloor K. The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. PLOS ONE. 2019;14(8):e0219731.

Shami E, Tabrizi JS, Nosratnejad S. The Effect of Health Insurance on the Utilization of Health Services: A Systematic Review and Meta-Analysis. Galen medical journal. 2019;8:e1411.

Adhikari SR, Maskay NM, Sharma BP. Paying for hospital-based care of Kala-azar in Nepal: assessing catastrophic, impoverishment and economic consequences. Health policy and planning. 2009;24(2):129-39.

Departement of Health. Annual Report. 2016.

Ghimire R. Community Based Health Insurance Practices in Nepal International Research Refereed 2013;2(4).

Adhikari SR. An Evaluation of Nepal's Free Health Care Schemes: Evidence from a Quasi-Experimental Design SSRN Electronic Journal. 2013.

Ghimire S, Ghimire S, Khanal P, Sagtani RA, Paudel S. Factors affecting health insurance utilization among insured population: evidence from health insurance program of Bhaktapur district of Nepal. BMC Health Services Research. 2023;23(1):159.

Department of Health. Annual Report 2019-2020. 2020.

Paudel B. Challenges for implementation of the health Insurance program in Nepal: Implementor's Perspectives Oslo Metropolitan University 2021.

Health Insurance Board N. Annual Report 2077/078. Nepal; 2021.

Gurung G. Private gain, public pain does a booming private healthcare industry in Nepal benefit its people: The BMJ Opinion; 2016 [Available from:

Mishra SR, Khanal P, Karki DK, Kallestrup P, Enemark U. National health insurance policy in Nepal: challenges for implementation. Global health action. 2015;8:28763.

Silwal PR, Ashton T. Productivity of public hospitals in Nepal: a data envelopment analysis. BMJ open. 2017;7(7):e015327.

Paneru DP, Adhikari C, Poudel S, Adhikari LM, Neupane D, Bajracharya J, et al. Adopting social health insurance in Nepal: A mixed study. Frontiers in public health. 2022;10.

Osei Afriyie D, Krasniq B, Hooley B, Tediosi F, Fink G. Equity in health insurance schemes enrollment in low and middle-income countries: A systematic review and meta-analysis. International journal for equity in health. 2022;21(1):21.

Bose M, Dutta A. Health financing strategies to reduce out-of-pocket burden in India: a comparative study of three states. BMC Health Serv Res. 2018;18(1):830.

Stenberg K, Hanssen O, Edejer TT, Bertram M, Brindley C, Meshreky A, et al. Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries. The Lancet Global health. 2017;5(9):e875-e87.

Siddiqi A, White PB, Mistry JB, Gwam CU, Nace J, Mont MA, et al. Effect of Bundled Payments and Health Care Reform as Alternative Payment Models in Total Joint Arthroplasty: A Clinical Review. The Journal of arthroplasty. 2017;32(8):2590-7.

Lavin MA, Harper E, Barr N. Health Information Technology, Patient Safety, and Professional Nursing Care Documentation in Acute Care Settings. Online journal of issues in nursing. 2015;20(2):6.

Lin Y-K, Lin M, Chen H. Do Electronic Health Records Affect Quality of Care? Evidence from the HITECH Act. Information Systems Research. 2019;30(1):306-18.

Khanal GN, Bharadwaj B, Upadhyay N, Bhattarai T, Dahal M, Khatri RB. Evaluation of the National Health Insurance Program of Nepal: are political promises translated into actions? Health research policy and systems. 2023;21(1):7.

Hassan S, Mohammed J. Effective communication approaches as tool for achieving Universal Health Coverage through social health insurance in Nigeria. South Eastern European Journal of Public Health. 2023.

Maurya D, Kwan CY. Interactive governance and implementation effectiveness in India's National Health Insurance Program. Australian Journal of Public Administration. 2019;78(3):341-58.

Churikov DAEEVESVGAV. Monitoring the implementation of the National Healthcare Project. The Challenge of Sustainability in Agricultural Systems. 2021;1:817-8.

Grace N, Brian OO, Uche MC, Valentine UTJJoAiM, Sciences P. Assessment of National Health Insurance Scheme’s (NHIS) Effectiveness in a Tertiary Teaching Hospital in Southeast Nigeria. Journal of Advances in Medical and Pharmaceutical Sciences. 2017;13:1-9.

Gheorghe A, Straehler-Pohl K, Nkhoma D, Mughandira W, Garand DJ, Malema DR, et al. Assessing the feasibility and appropriateness of introducing a national health insurance scheme in Malawi. Global Health Research and Policy Journal. 2019;4.

Pokharel R, Silwal PR. Social health insurance in Nepal: A health system departure toward the universal health coverage. The International journal of health planning and management. 2018.

Yohanes F, Imam H, Ernawati E. Fraud Issues in the National Health Insurance (Causes, Legal Impacts, Dispute Settlement and Preventive Measures). Jurnal Multidisiplin Madani. 2022;2(4):1663-80.






Original Article


How to Cite

Healthcare provider’s experience and attitude towards the national health insurance program of Nepal. IJPHAP [Internet]. 2024 Jun. 7 [cited 2024 Jun. 20];3(5):48-62. Available from: