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Implementation bottlenecks of the National Health Insurance program in Nepal: Paving the path towards Universal Health Coverage: A qualitative study

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  • Gaj Bahadur Gurung
  • Alessio Panza

Abstract

Most low and low‐middle income countries adopting National Health Insurance (NHI) programs to achieve Universal Health Coverage are struggling to implement the program due to underlying problems at implementation. However, there is a lack of research that focuses on these problems. The Nepal NHI program initiated in 2016 has experienced numerous implementation challenges. This qualitative study delves into the NHI program's inputs and throughputs/implementation bottlenecks. The study based in Nepal's four districts included 28 in‐depth interviews, six focus group discussions, and identified 12 themes that pointed to the NHI program's inadequate inputs causing bottlenecks. The analysis employed the Grounded Theory. The main challenges identified were insufficiently defined NHI implementations guidelines, conflicting Act clauses, a lack of HIB organizational guidelines, and inadequate human resources. The major throughput bottlenecks were difficulty enrolling the insurees, the inability to select the health providers competitively and to act as a prudent purchaser of the services. These inadequate inputs and throughput bottlenecks led to negative outputs such as insurees' high dropouts, and low coverage of poor households. The NHI program's sustainability might be at stake if the identified problems persist, further exacerbated by the plummeting economic situation in the country due to COVID‐19.

Suggested Citation

  • Gaj Bahadur Gurung & Alessio Panza, 2022. "Implementation bottlenecks of the National Health Insurance program in Nepal: Paving the path towards Universal Health Coverage: A qualitative study," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(1), pages 171-188, January.
    • Handle: RePEc:bla:ijhplm:v:37:y:2022:i:1:p:171-188
    DOI: 10.1002/hpm.3301
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    References listed on IDEAS

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    1. Rajani Pokharel & Pushkar Raj Silwal, 2018. "Social health insurance in Nepal: A health system departure toward the universal health coverage," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(3), pages 573-580, July.
    2. World Bank, "undated". "South Asia Economic Focus, Spring 2020," World Bank Publications - Reports 33478, The World Bank Group.
    3. Maurya, Dayashankar & Ramesh, M., 2019. "Program design, implementation and performance: the case of social health insurance in India," Health Economics, Policy and Law, Cambridge University Press, vol. 14(4), pages 487-508, October.
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    Cited by:

    1. Sharma, Hari & Smieliauskas, Fabrice, 2022. "Undernutrition inequality between Dalits and non-Dalits in Nepal – A decomposition analysis," World Development, Elsevier, vol. 159(C).

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