Navigating Nepal’s health financing system: A road to universal health coverage amid epidemiological and demographic transitions

Resham B. Khatri; Pratik Khanal; Dipendra Singh Thakuri; Prabesh Ghimire; Mihajlo Jakovljevic

doi:10.1371/journal.pone.0324880

Abstract

Background

Nepal has been undergoing demographic and epidemiological transitions, marked by an increasing burden of non-communicable diseases (NCDs) and injuries. These transitions have led to financial implications, including rising out-of-pocket (OOP) expenses. This study reviews and synthesizes evidence on the status, issues and challenges in health financing system, policies, and programs to achieve universal health coverage (UHC) in Nepal.

Methods

We conducted a scoping review of literature on Nepal’s health financing system, policies, and programs. A search strategy was developed using keywords related to two core concepts: health financing and universal health coverage. Grey literature was identified from the web pages of relevant ministries and organizations. A total of 148 studies/policy documents published in Nepali and English up to 31 December 2024 were included. Policies and content related to the health financing system were reviewed to understand the status, issues and challenges of health financing functions, and UHC . A framework-guided deductive content analysis approach was employed, and findings were interpreted using the three UHC components: service coverage, population coverage, and financial coverage.

Results

Nepal’s health policy documents prioritize financial protection for low-income people and target groups through social health protection programs/schemes. However, multiple social health protection schemes coexist with fragmented risk pooling and low efficiency in health financing. OOP expenditure is high at 54.2%, with 10% of the population facing catastrophic health expenditures. Injuries and chronic morbidities contribute significantly to this burden, with 70% of injury-related and 62% of NCD-related expenses borne through OOP payments. Despite efforts to improve financial risk protection, the National Health Insurance Program (NHIP) suffers from low population coverage (28%), low renewal rate (54%), and financial sustainability issues (as provider payments exceed revenue collection). The UHC service coverage index, though improving, was only 54 out of 100 in 2021 reflecting limited health system capacity and insufficient readiness to address health challenges, including those posed by shifting demographics and the growing burden of NCDs. Nepal’s total health expenditure remains around 2% of GDP, with persistent inefficiencies in resource allocation, fiscal decentralization, and budget absorption.

Conclusions

Nepal’s health financing policies align with UHC goals, yet critical gaps remain in multiple dimensions . Issues such as inefficiencies, underfunding, and fragmented social health protection schemes limit equitable access to quality health care. Therefore, comprehensive structural reforms-spanning legal, institutional, and policy frameworks-are urgently needed. Key reforms include: (1) merging or harmonizing existing social health protection schemes for efficient pooling and purchasing; (2) enhancing domestic health financing through increased health funding (≥5% of GDP) via payroll contributions, progressive taxation, and earmarked sin taxes; (3) reforming NHIP to mandatory enrollment starting from formal sector, subsidizing premium for informal sector and free coverage for disadvantaged groups, alongside strengthening policy implementation including accrediting of health facilities, ensuring service quality, prioritising and expanding coverage packages with strategic purchasing from all public and private health facilities; and (4) equitable public financing to ensure needs-based allocation across government levels that respond to demographic and epidemiological patterns. Further research is needed to assess hybrid tax and premium based insurance models, strategic purchasing optimization, and digital health innovations for financial sustainability.

Citation: Khatri RB, Khanal P, Thakuri DS, Ghimire P, Jakovljevic M (2025) Navigating Nepal’s health financing system: A road to universal health coverage amid epidemiological and demographic transitions. PLoS One 20(5): e0324880. https://doi.org/10.1371/journal.pone.0324880

Editor: Himanshu Sekhar Rout, Utkal University, INDIA

Received: June 13, 2024; Accepted: April 30, 2025; Published: May 29, 2025

Copyright: © 2025 Khatri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: BHS, Basic Health Services; CHEs, Current Health Expenditure; CMNN, Communicable, Maternal, Neonatal, And Nutritional Diseases; COPD, Chronic Obstructive Pulmonary Disease; CVDs, Cardiovascular Diseases; EPF, Employee Provident Fund; FY, Fiscal Year; GDP, Gross Domestic Product; GoN, Government of Nepal; HIB, Health Insurance Board; IHD, Ischemic Heart Disease; LMICs, Lower Middle-Income Countries; MCH, Maternal and Child Health Services; MOHP, Ministry of Health and Population; NCDs, Non-Communicable Diseases; NHA, National Health Account; NHF, National Health Financing; NHIP, National Health Insurance Program; NHS, Nepal Health Sector; NPR, Nepalese rupees; OOP, Out-of-Pocket; PEN, Package of Essential NCD; PHC, Primary Health Care Centers; PHEs, Public health emergencies; PHS, Public Health Service; RTAs, Road Traffic Accidents; SES, Socio-Economic Status; SHSDB, Social Health Security Development Board; SSF, Social Security Fund; SSS, Social Security Scheme; SSU, Social Service Unit; UHC, Universal Health Coverage.

Introduction

Nepal’s healthcare delivery system comprises a mixed network of public and private health facilities (HFs). Public HFs operate across federal, provincial, and community levels, providing Basic Health Services (BHS) and specialized care. The BHS—essential primary care is delivered through basic health service centers, health posts, primary healthcare centers, and basic hospitals [1], while specialized care is delivered via referral hospitals (e.g., provincial, federal, teaching, and super-specialty hospitals). Private HFs, concentrated in urban areas, offer services ranging from routine care to advanced treatments through hospitals, clinics, and pharmacies [2].

In line with its healthcare delivery system, Nepal employs a mixed health financing system, combining publicly funded health programs and services with private payment for healthcare services [3, 4]. The Government of Nepal (GoN) allocates funds to the health sector through its budget, pooling resources from various financing sources to reimburse healthcare providers [3]. Major sources include public funding (e.g., direct and indirect taxes, customs duties), private contributions (e.g., household out-of-pocket (OOP) payments, private insurers), and grants or loans from external development partners [4].

Over the past three decades, Nepal has witnessed significant changes in its demographic and epidemiological disease patterns [5]. These changes include general population growth (from 18.4 million in 1991 to 29.9 million in 2021) and an increase in life expectancy (from 54.9 to 71.2 years), leading to a rise in the elderly population (aged >60 years) from 5.8% to 10.21% during the same period [6]. There has also been a shift in the disease burden, transitioning from infectious diseases to non-communicable diseases (NCDs) and other conditions such as unplanned urbanization, climate change, antimicrobial resistance, and injuries [7]. For instance, the proportion of the population reporting NCDs increased from 6.5% in 1995/96 to 18.5% in 2022/23 [8].

In 2019, out of an estimated 193,331 deaths in Nepal, 71.1% were attributed to NCDs, 21.1% to communicable, maternal, neonatal, and nutritional diseases (CMNN), and 7.8% to injuries [7]. Among NCDs, cardiovascular diseases (CVDs) were the leading cause of death, accounting for 24% of fatalities, with higher rates among males (26.8%) than females (20.7%). Chronic obstructive pulmonary disease (COPD) caused 16.3% of deaths, up from 6.1% in 1990, while ischemic heart disease (IHD) accounted for 12.3%, up from 4% [7]. Unplanned urbanization has significantly contributed to the disease burden, particularly in major urban cities compared to rural areas [9]. Additionally, other emerging challenges include the emergence of vector-borne diseases and increased threats from public health emergencies (PHEs), such as natural disasters, floods, suicide, and road traffic accidents (RTAs) [7]. These transitions have profound implications for morbidity, as measured by Disability-Adjusted Life Years (DALYs), and mortality, particularly in terms of Years of Life Lost (YLL) [7].

Nepal’s epidemiological shifts and demographic transitions, combined with PHEs, could pose significant challenges to achieving Universal Health Coverage (UHC) by 2030. This is particularly true if financial barriers to accessing health care remain unaddressed. The lack of adequate financial risk pooling has led to high OOP expenditures, which have consistently accounted for 55% to 60% of current health expenditure (CHE) over the past two decades [10], which is significantly higher than the global average of 28.16%[11] and the WHO-recommended threshold of 15–20% to prevent financial hardship [12]. For high-income countries, the average OOP expenditure is 16.96%, while for Lower Middle-Income Countries (LMICs), it is 38.11%[12]. Comparatively, neighboring countries like Bangladesh report very high OOP expenditures at 72.99%, while India and Sri Lanka have lower OOP expenditures than Nepal (49.82% and 43.64%, respectively)[13]. In contrast, Thailand, with its stronger public health system, has reduced OOP expenditures to below 10% through robust public financing and risk-pooling mechanisms [11]. Similarly, Nepal’s reliance on external funding for health (around 10.35% of total health expenditure) is slightly higher than the regional average of 9.89% for the WHO South East Asia Region, but lower than the LMICs average of 18.2%, underscoring Nepal’s continued dependence on donor support [11].

Alarmingly, one in ten Nepalese households spend more than 10% of their income on health care, and 1.7% of the population falls into poverty annually due to OOP payments [14]. Despite growing awareness among stakeholders about the shifting disease burden and high OOP expenses, Nepal’s health system remains inadequately prepared to address these challenges. The system faces limitations in service capacity, resilience, and the ability to manage the health financing implications of the emerging burden of diseases and conditions [15–18]. This highlights the urgent need for Nepal to strengthen financial risk pooling mechanisms to reduce reliance on OOP payments and improve financial protection.

Nepal’s health system and policy began evolving after the establishment of a constitutional monarchy in 1990 (replacing party-less Panchayat government) [19], followed by the introduction of the first national health policy in 1991[20]. Subsequent political turmoil and transitions, including the Maoist insurgency, and formation of political alliances, led to the adoption of the Interim Constitution in 2007 [21]. In 2025, Nepal adopted a new Constitution, establishing a federal republic and a federalized health system [22]. Grounded in socialist values, the constitution recognizes BHS as a fundamental right, mandating their provision free of charge to all citizens, along with additional health services through the national health insurance program (NHIP) [22]. In line with these constitutional commitments, several health policies have been introduced and implemented to ensure financial protection and improve service coverage. These include Nepal’s Health Sector (NHS) Strategy (2023–2030), the National Health Financing (NHF) Strategy (2023–2033), and the Health Insurance (HI) Act 2017 [23–26]. In 2016, the GoN launched the NHIP to address financial barriers to health care and reduce OOP expenses [14]. However, the NHIP faces significant challenges, including low population coverage, high dropout rates, and an inadequate benefit package (in terms of services and cost coverage) [14, 27, 28]. To fulfil its constitutional mandate of providing health services, the GoN has implemented various social health protection programs and schemes, such as BHS, the Safe Delivery Incentive Program (Aama Program), the Free Newborn Care Program, the Impoverished Citizen Treatment Fund, special financial benefits for health treatment, and social service units, among others [3, 14]. Nepal has committed to achieving UHC and other health-related targets under Sustainable Development Goal Three (SDG 3) by 2030 [29]. Despite substantial investments, efforts, and progress, financial health protection initiatives have yet to translate into effective health coverage for all [14, 30]. Existing social protection programs and schemes are characterized by overlapping entitlements regarding population coverage and benefit packages, and fragmentation that limits risk pooling across population groups [30–32].

In Nepal, a large body of literature focuses on factors associated with health insurance, service utilization status [28, 33, 34], user satisfaction with health insurance schemes [35], household-level healthcare expenditure patterns [36], and causes of dropout from health insurance [37]. These studies are small-scale, standalone or community-level studies that examine community- or service-level drivers of financial health protection. There is a notable gap in comprehensive analyses of the health financing trajectory in relation to constitutional mandates, national policies, and health programs since the 1990s. Specifically, policy reviews that analyze the health financing landscape of Nepal using the three dimensions of the UHC (i.e., population, service, and financial coverage) and health financing functions remain scarce. This study thus provides a comprehensive policy-level analysis of Nepal’s health financing trajectory using a UHC lens. By systematically examining the evolution of health financing policies since the 1990s, this study assesses their alignment with constitutional mandates, financial risk protection commitments, and equity considerations amid epidemiological and demographic shifts. Using a mixed-method policy review approach, it bridges critical evidence gaps by evaluating the effectiveness and sustainability of financing mechanisms in addressing financial vulnerabilities of the population. This study offers new insights into how different financing mechanisms interact to advance UHC, contributing to a broader understanding of the policy landscape and informing future reforms for equitable health financing in Nepal. These findings will support program managers and policy stakeholders in ensuring that health financing policies and programs remain responsive to the country’s evolving demographic and epidemiological patterns.

Methods

Study design

We conducted a scoping review of published literature on Nepal’s health financing-related policies and programs, examining their status, issues, and challenges in achieving UHC. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) Guideline [38] [Supplementary Information, S1 Table]. We adhered to the methodological framework of scoping reviews proposed by Arksey and O’Malley (2005)[39], which was further refined by Levac and colleagues (2010) [40]. This framework includes six steps: (a) identifying research questions, (b) identifying relevant documents, (c) selecting documents, (d) extracting and charting data, (e) summarizing and reporting findings, and (f) engaging public and expert involvement. The scoping review design is well-suited for mapping broad evidence landscapes on this topic.

Identifying research question

The following question guided the scoping review: What are the status, issues, and challenges of the health financing system in Nepal in relation to progress toward UHC, in terms of population and service coverage, as well as financial risk protection?

Identifying relevant documents

We used search terms combining two concepts with a geographical focus on Nepal: health financing (e.g., social protection, health financing, health insurance) and universal health coverage (population, service, and financial risk protection). We searched PubMed, Embase, and Scopus [Supplementary Information, S2 Table] and reviewed references from selected papers to identify additional studies. The first four authors, who are familiar with Nepal’s health system and academic/grey literature, identified grey literature through team discussions, professional networks, Google searches, and government websites. Additionally, we searched using similar search terms on Google and government websites. The grey literature included survey reports, policy documents (constitutions, acts, regulations, policies, plans, strategies), conference presentations, and news articles. We compiled a list of documents, discussed their relevance, and reached a consensus on inclusion. We also reviewed Nepal’s country profiles and reports from the Institute for Health Metrics and Evaluation (IHME), the World Bank, and the WHO.

Selection of documents

We searched for all relevant documents addressing health financing and UHC in Nepal [Supplementary Information, S3 Table]. Records were imported and managed using EndNote 20. The inclusion criteria were: (i) relevance to health financing/UHC themes and (ii) a detailed focus on Nepal. Screening was initially conducted based on the title and abstract by the first author and further assessed by the second author. This was followed by a full-text screening, initially performed by the first author and reviewed by the third and fourth authors. The data search was conducted during the first week of May 2024 (updated during the first week of January 2025). We included relevant literature written and published in Nepali or English up until 31 December 2024 (no starting date was applied in the search). Grey literature was included to emphasize its relevance to policy gaps. To minimize any bias from grey literature, we primarily relied on official government reports and published official documents, cross-validated with peer-reviewed studies where available. In cases of limited grey literature, we consulted three independent PhD candidates with expertise in Nepal’s health and financing systems to ensure data appropriateness, accuracy, and to mitigate bias. This approach was discussed and agreed upon by the authors to enhance data reliability.

Extraction and charting of data

We extracted health financing content from the selected documents. The extracted data were discussed among the authors for analysis and interpretation, aligned with the UHC framework [41,42]. The content was organized into a Word file under UHC framework components (population, service, and financial coverage) and reviewed collaboratively. The first author led the data extraction and analysis. When inconsistencies or ambiguities arose, such as variations in terminology, differences in reported figures, or misalignment with UHC dimensions, these were flagged and systematically discussed among the authors. Resolution involved cross-checking with primary documents, seeking consensus through predefined inclusion criteria, and documenting decision rationales. Any disagreements were addressed through deliberation, reconsideration of the review questions, and alignment with the analytical framework, ensuring relevance to policy content related to health financing status, challenges, and programs/services aligned with the UHC framework.

Summarizing and reporting the findings

To guide our analysis, we adopted the three interlinked components of the UHC framework for health financing: population, service, and financial coverage [41]. The UHC framework encompasses population coverage (ensuring all people have access to the full range of quality health services they need, when and where they need them), financial coverage (protecting individuals from financial hardship), and service coverage (encompassing the full continuum of essential health services) [42]. Population coverage refers to access to health services by population groups, while service coverage refers to the health services or interventions available to the population. Finally, financial risk protection or coverage protects individuals from financial hardship when seeking health care services. Data analysis was conducted in two phases. In the first phase, health financing-related policies and programs were reviewed. Using data from peer-reviewed studies and grey literature, the status, issues, and challenges of the policies were presented, and the coverage status of UHC for each program/scheme was also presented. In the second phase, we further explained the status and challenges of UHC coverage. For this, data were analyzed using a framework-guided deductive content analysis (extracting data and fitting them into the pre-identified components of the framework). Then, we grouped similar content across each component of the UHC framework, synthesized the findings, and provided a narrative explanation.

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Table 1. Overview of health financing in policy documents of Nepal: Status, issues and challenges.

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Table 2. Health financing functions in different social health protection schemes in Nepal.

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Public and experts’ involvement

The scoping review did not directly involve patients or the public. However, we consulted professionals working in the field to identify relevant documents, policies, and guidelines on health financing (see Acknowledgements). To validate and confirm our findings, we reviewed expert opinions from publicly available platforms, such as YouTube and live-recorded videos of presentations and talks at national conferences. Notable events included the ‘National Summit of the Health and Population Scientists in Nepal’, organized by the Nepal Health Research Council in 2022, 2023, and 2024 and the international conference on ‘Resilient and Inclusive Social Protection: Investing in Human Capital Development’, organized by the National Planning Commission in 2022. Additionally, we consulted with three PhD candidates specializing in health economics and health systems, who have expertise in health financing in Nepal, to review the manuscript and ensure factual accuracy. Since the study used secondary data, ethical approval from an institutional review board was not required.

Results

A total of 148 documents were included in the analysis including government documents (40), reports/surveys (36), online databases (4), conference presentations/ panel discussions (4), newspaper reports (3), and peer-reviewed articles identified through hand search (8) [Fig 1] [see details in Supplementary Information, S3 Table}.

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Fig 1. PRISMA-ScR flow chart for selection of studies for the review.

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Health financing landscape

Table 1 provides an overview of the evolution of health financing policies, highlighting the associated issues and challenges [see Supplementary information, S1 Fig]. The constitutional focus on health and health financing has evolved across the three constitutions since 1990: the Constitution of the Kingdom of Nepal (1990) framed health as a non-binding directive, reliant on state budgets and donors, with high OOP costs (~70%) [19], the Interim Constitution of Nepal 2007 (2007–2015) established health as a fundamental right, mandating free basic health services and introduced equity-focused financing [21], and the Constitution of Nepal 2015, which institutionalized federal health governance, free basic health services, and mandates ensuring for citizens are not deprived of emergency care, and decentralized resource allocation [22].

In addition to constitutional provisions, several key legislative frameworks have shaped health financing. These included the Health Insurance Act 2017, which introduced mandatory insurance and subsidized premiums for marginalized groups [23], the Public Health Service (PHS) Act 2018, which defined standards and criteria for free basic health services, emergency care, and public health governance[52]), Social Health Security Development Committee (SHSDC) (Formation) Order 2014, which mandated the establishment of SHSDC for designing and introducing the social health insurance (SHI) in Nepal [44] and Health Insurance Regulation 2019 (operationalized premium rates and claims processes) [56].

Since the 1990s, three National Health Policies (NHP) have been implemented: the NHP 1991, focused on donor-dependent health financing models [57]; NHP 2014 introduced SHI and decentralization, reducing donor reliance and aligning aid [61], while NHP 2019 emphasized domestic funding and the expansion of SHI [64]. The National health Insurance Policy 2013 also laid the foundation for universal coverage through a health insurance program [68].

The evolution of health sector implementation plans further reflects shifts in health financing priorities. The first NHS Program-Implementation Plan 2004–2009 was centered on donor funding, and centralized financing [94], while NHS Program-Implementation Plan II (2010–2014) piloted SHI, promoted decentralization, and introduced mixed financing models [69], The NHS Strategy (2015–2022) focused on federal resource allocation, SHI expansion, and digital integration [70], and NHS Strategic Plan (2023–2030) shifted health financing towards greater reliance on domestic resources, while strengthening and streamlining social protection schemes to promote sustainability and equitable access [25]. Finally, the National Health Financing (NHF) Strategy (2023–2033) aims to achieve tax-based financing for BHS and premium-based universal health insurance [26].

Despite progress, such as reduced OOP costs, challenges persist, including low SHI enrollment, gaps in federal coordination, and inequitable access to services. The trends reflect a shift from donor reliance to domestic resource mobilization, from centralized to decentralized governance, and an incremental expansion of SHI, all aiming toward UHC. Policies have evolved from initial resource mobilization efforts to robust financial management and, ultimately, to the comprehensive integration of social health protections, culminating in formulating and implementing the NHIP.

Health financing functions of social health protection schemes in Nepal

Table 2 presents different social health protection schemes/programs, and their health financing functions [see Table 2]. The health financing system in Nepal is predominantly tax-funded (through general taxation). Premium-based schemes like NHIP and private insurance are emerging as complementary mechanisms. Tax-funded programs (e.g., public financing, BHS) rely on central and local government pooling, and NHIP and the social security fund (SSF) demonstrate effective national-level pooling mechanisms. Tax-funded programs often lack a purchaser-provider split, limiting efficiency and accountability. They use input-based budgets and block grants, while NHIP and private insurance use performance-based payment mechanisms (e.g., capitation, case-based payments).

Table 3 outlines the health programs and evaluates their UHC dimensions. Nepal’s health programs vary in service, population, and financial coverage. Public financing (through public providers) offers immunization, nutrition, and MCH services, with 76% outpatient utilization and free care for vulnerable groups. Free health care provides basic services but has been replaced by the the BHS program. BHS covers 10 primary care and preventive services and 98 medicines for all citizens. The Safe Motherhood Program covers maternal health services. The impoverished citizen treatment fund targets chronic diseases but has limited financial coverage. NHIP covers 28% of the population but faces high dropout rates. Private Insurance has low coverage, while the employee provident fund (EPF) and SSF support formal sector workers. Geriatric Health Services aid seniors but lack rural access.

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Table 3. Health programs and coverage as per UHC dimensions in Nepal.

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Service coverage

Key themes under this component include health system capacity for NCD-related health services, health system readiness to address emerging disease burdens, and constraints in service coverage.

Health system capacity for NCD-related health services.

Nepal has implemented multiple health programs focused on maternal and child health and nutrition. Donor-supported disease control programs have reduced the burden of infectious diseases such as malaria, tuberculosis, and HIV/AIDS [14, 102, 103]. By 2019, COPD and IHD had replaced respiratory infections and CMNN-related deaths (1991) as leading causes of mortality [7]. Risk factors like air pollution, tobacco use, and poor diets have driven the rising NCD burden [7]. Sedentary lifestyles and unhealthy diets (e.g., high carbohydrate/fat intake) are now widespread. For instance, obesity among women of reproductive age surged from 0.2% (1996) to 4.1% (2016), while overweight prevalence rose from 2% to 20% in the same period [104].

Between 2000 and 2021, Nepal’s UHC service coverage index increased from 20% to 54% [11] [Fig 2], with gains in maternal/child health (41% → 77%), infectious diseases (7% → 62%), and NCDs (20% → 46%). However, health system capacity (e.g., human resources, hospital beds) improved only marginally (25% → 37%) [11], leaving Nepal with the lowest health system capacity in South-East Asia [18, 105, 106].

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Fig 2. UHC service coverage index for Nepal (Source [11]).

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Health system readiness to address emerging disease burdens.

Injuries account for 7.6% of deaths, driven by RTAs (23/100,000) and suicide (9/100,000) [7, 18, 107]. Despite rolling out the package for essential NCD (PEN) interventions in 2016, preventive measures and multi-sectoral policies remain underprioritized [24, 108]. Diagnostic services for NCDs (e.g., diabetes, CVDs) have expanded since 2015, but health system readiness remains suboptimal [109]. Public health laws (e.g., air quality, food safety) and mental health interventions are inadequately enforced [4, 110-111].

Constraints of service coverage.

Deficiencies include poor infrastructure, workforce shortages, inequitable resource distribution, and delayed budgets [112]. High transport costs hinder obstetric care access [113], while low awareness of free services limits healthcare utilization among older adults [114, 115]. NHIP offers a limited service package, excluding certain types of care [116]. Service coverage and utilization remain low due to voluntary membership, limited public trust, restricted choices of HFs, drug shortages, long waiting times, low priority for insured patients, providers’ negative attitudes, moral hazard, and an inadequate benefit package [28, 33-35, 116–121].

Population coverage

Key themes under this component were access to HFs for services, utilization of health insurance, and shifting demographics and disease burdens.

Access to HFs.

Nepal has a health system with an extensive network of HFs, including 234 public hospitals, 184 primary health care centers (PHCCs), 3,769 health posts, and 7,651 basic health service centers [122, 123]. Over 2,000 non-public facilities and approximately 28,000 registered pharmacies primarily provide curative services [122]. Despite plans to build hospitals in all 753 local units by 2020/21, only 322 were under construction by May 2024 due to funding gaps [45, 124]. Moreover, despite the government’s efforts, persistent inequities continue to hinder progress toward UHC, exacerbated by limited physical access to HFs and low socioeconomic status (SES) [45]. Rural populations face stark inequities: 61% can reach a health post within 30 minutes [8].

Health insurance utilization.

Coverage remains low but rose from 25% (FY 2022/23) to 28% (FY 2023/24) [125] [Supplementary Information, S1 Fig]. Renewal rates are suboptimal (54% over two years) [125]. Enrollment is higher among educated individuals (particularly household heads), advantaged castes/ethnicities, high-income households, and those with chronic illnesses or comorbidities [116, 126–128]. Health service utilization is greater among partnered individuals, female-headed households, families in accessible geographic areas, and people aged over 60 [103, 114, 115, 129]. Conversely, dropout rates are disproportionately high among affluent households, migrants, local political leaders, poor households, Dalits (a marginalized ethnic group), and households in rented accommodations or with perceived good health status [116, 120, 126-128, 130]. These disparities highlight systemic challenges in NHIP, including pro-rich bias and inequitable pricing structures [116, 131].

Shifting demographics and disease burden.

Nepal’s demographic structure is shifting toward an aging population, accompanied by a sharp rise in NCDs such as CVDs, cancers, and respiratory conditions (Fig 3) [8, 9], along with changing demographic structure [133]. This demographic transition has exacerbated the prevalence of NCDs and injuries, which now account for a growing share of the total disease burden, measured in DALYs [7, 24, 45].

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Fig 3. Increasing NCD burden in Nepal over the last three decades.

Source: Our World in Data [132].

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Concurrently, Nepal’s rapidly ageing population has shortened the window of demographic dividend while increasing demand for healthcare services, particularly for chronic and age-related conditions [Supplementary Information, S3 Fig] [132]. The upward trend in DALYs among older adults underscores the urgent need to expand NCD prevention and treatment programs, strengthen health literacy initiatives, and address systemic gaps in care delivery [7, 24, 45].

Financial coverage

Key themes under this component included high OOP and financial burden due to NCDs, disproportionate budget allocation to local governments, and inequitable financial risk protection in healthcare.

High OOP and financial burden due to NCDs.

The 2019/20 National Health Account (NHA) report highlights that OOP expenses in Nepal remain alarmingly high, accounting for 54.2% of CHE and reflecting systemic challenges such as inadequate government healthcare spending, ineffective social health protection schemes, and rising financial burdens on households [134]. Approximately 10% of the population faces catastrophic health expenditure (using the 10% threshold), while 1.7% are impoverished due to OOP costs (based on the $1.90 PPP threshold) [135]. These burdens disproportionately affect vulnerable groups, including the elderly, rural residents, low-income households, and individuals with chronic illnesses such as diabetes, asthma, and CVDs [136–141].

Expenditures on hypertension, CVDs, and cancers (e.g., lung, breast, cervical) constitute a significant share of CHE for both outpatient and inpatient services, with variations tied to age, socio-economic status (SES), illness severity, and perceived susceptibility [27, 142, 143]. Similarly, patients with cancers (lung, breast, cervical) face substantial financial strain, with medical costs accounting for 81% of total treatment expenses [139, 142]. Injuries (e.g., road traffic accidents) and chronic comorbidities drive catastrophic spending, with 70% of injury-related costs and 62% of NCD-related expenditures financed through OOP payments [77, 136, 138]. Industrial workers hospitalized for acute or chronic conditions face particularly severe financial strain: 13% experience CHE, and 42% resort to distress financing (e.g., loans, subsidies), primarily due to drug and diagnostic costs [137, 144]. Low-income households frequently depend on subsidies (43%) and loans (29%) to cover NCD treatments, exacerbating financial insecurity [8].

Health financing inequities

As shown in Fig 4, OOP expenditures have remained above 50% of total health spending for over two decades, underscoring Nepal’s regressive health financing system, which disproportionately impacts the poorest income quintiles [119, 145, 146]. Despite a total health expenditure of ~2% of GDP—far below the global average of 5%—the government struggles to increase budget allocations, improve absorption rates, or curb last-minute fiscal reallocations, hindering progress toward UHC [147–149]. Domestic health spending accounts for nearly one-third of CHE, while NCDs and injuries now represent 42.6% of CHE, up sharply in recent years [134, 150].

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Fig 4. Trend in health financing indicators in Nepal (2000–2021).

Data source: World Bank (https://data.worldbank.org/).

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Persistent inequities in health budget allocations for NCDs and injuries further perpetuate high OOP spending (Fig 5) [151–153].

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Fig 5. Health expenditure by programs/diseases/health conditions in Nepal (NHAs 2015/16–2019/20) [151, 152].

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Disproportionate budget allocation to local governments.

Over the last three fiscal years (FY 2022/23–2024/25), Nepal allocated NPR 103 billion, 84 billion, and 86 billion to local governments, respectively [45]. Fig 6 illustrates the distribution of health budgets across Nepal’s federal, provincial, and local tiers of government during this period, revealing stark disparities in funding. Despite incremental increases in allocations to local governments, the federal level retains a disproportionately large share of the budget, underscoring persistent imbalances in fiscal decentralization [45, 125, 154, 155].

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Fig 6. Health budget distribution across Nepal’s three tiers of government.

Source: Progress of Health and Population Sector 2023/24 (2080/81)[45].

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Inequitable financial risk protection in health care.

Although Nepal’s NHIP is legally mandatory, it functions as a voluntary program due to ineffective enforcement mechanisms, hindering population coverage expansion [14, 156]. Despite subsidies for underprivileged groups, Nepal’s system for identifying marginalized and ultra-poor populations remains flawed [156]. Low insurance enrollment, high healthcare costs, limited risk pools and budget constraints further undermine efforts to support vulnerable groups [144, 157]. Key factors contributing to the NHIP’s underperformance include: voluntary enrollment; conflicts of interest among health policymakers, politicians, private providers, and trade unions; ambiguous guidelines; contradictory legal provisions; the HIB’s lack of a formal organizational structure; enrollment challenges; and its inability to competitively select providers or act as a strategic purchaser of services [27, 130, 156, 158, 159].

Rising healthcare costs in public and private sectors disproportionately limit financial access for marginalized groups [160]. Rural residents face crippling OOP expenses, with drugs constituting 85% of OOP costs among the poorest quintiles [10]. Non-medical expenditures (e.g., food, transportation) often exceed direct medical costs for individuals seeking care [156, 161, 162].

The PHS Act (2018) prohibits public funding for foreign medical treatments (Clause 30) [52]. However, the 2019 Standards Related to Treatment Expenses, Relief, and Financial Assistance introduced loopholes, restricting support to deprived individuals deemed to have “contributed to the nation” [163]. Politicians exploit these gaps to channel public funds—millions of rupees—toward overseas treatments for current/former elites, entrenching preferential treatment for advantaged groups [164] [See Supplementary Information, S4 Fig}. In other words, despite the prohibition of the PHS Act, political leaders continue to misuse public funds for personal health expenses via weaker legal tools like guidelines [165]. Although operational guidelines were developed to address this, they lack mechanisms to resolve systemic inequities or ensure accountability [166].

Discussion

This study examines Nepal’s health financing system through the lens of the UHC framework. The analysis highlights critical challenges affecting Nepal’s progress toward UHC, including demographic and epidemiological shifts, as well as gaps in policy responses. Nepal’s health financing system has transitioned from a donor-dependent model to a focus on domestic funding, aligning with the constitutional shift that frames health as a fundamental right of citizens. The health financing system is not aligned with evolving demographics and disease burden (e.g., rising NCDs). Furthermore, fragmented social health protection programs, both within and outside the health system, result in insufficient risk pooling and limited financial protection for marginalized populations, particularly for high-cost NCD treatments. Existing health services programs have limited benefit packages and low population coverage for treatment and care beyond the BHS package. Limited population-level interventions for NCD prevention contrast with heavy spending on treatment subsidies for chronic diseases, reflecting misaligned priorities. High OOP healthcare expenditures coexist with low health insurance coverage, exacerbating financial hardship. Disparities persist between privileged and disadvantaged groups in accessing affordable care. Health financing policies are undermined by inadequate institutional arrangements (e.g., weak laws, unclear organizational structures, fragmented policies) across governance levels.

Paradigm shift in health financing system and policy landscape in Nepal

Nepal’s health system has undergone significant constitutional, legal and financial transformations. Initially framed as a state-led welfare initiative under the 1990 Constitution [19], health was later recognized as a fundamental right in the 2007 Interim Constitution [21], culminating with the 2015 Constitution’s [22] emphasis on a federal, decentralized, inclusive health governance system aligned with global equity goals. Parallel shifts occurred in health financing, transitioning from donor-dependent, centralized models in NHP 1991 [57] to a priority on domestic funding and emergency health funds [64]. Current trends reflect a shift toward domestic resource mobilization, decentralization, and crisis preparedness [31, 124]. However, implementation of these constitutional obligations poses significant challenges considering Nepal’s economy and public sector budget constraints. For instance, Nepal’s small economy, with a total GDP of $40 billion, is largely reliant on agriculture, services (tourism) and remittances [167]. Its informal sector, comprising unregistered small and middle enterprises, and subsistence farming, accounts for roughly 39% of economic activity as a share of GDP, largely in the agriculture sector [168]. This informality poses significant challenges, limiting tax revenue and formal job creation, and weakening the country’s fiscal base. Additionally, Nepal faces a persistent trade deficit of up to 15.5% [169], while foreign grants and loans finance one-third of the national budget [169]. High recurrent costs consume two-thirds of the budget, leaving limited funds for development [170].

Tax-funded social security programs account for 16.6% of the total government expenditure and 4.9% of GDP [32], raising concerns about the sustainability of welfare schemes such as the old-age allowance [171]. Similar budgetary constraints impact the health sector, where long-term investments remain inadequate. Nepal’s public health spending stands at less than 2% of GDP [14, 154, 172], far below the WHO-recommended 5% needed to limit OOP payments and achieve UHC [12]. This level of spendings also lag behind regional counterparts [13], highlighting a critical funding gap. More than three-quarters of government health expenditure is allocated to recurrent costs, highlighting chronic underfunding of capital investments [154]. This shortfall hinders infrastructure development, such as rural health centers and diagnostic facilities. Furthermore, Nepal’s over-reliance on donor funding poses sustainability risks if aid diminishes [173, 174]. Ensuring long-term financial sustainability is further complicated by systemic inefficiencies, wastage, and corruption which undermine effective resource utilization [67, 175]. Addressing these challenges requires strategic reforms in health financing, improved fiscal discipline, and enhanced efficiency in resource allocation. Strengthening federal coordination and enhancing budget transparency are equally crucial to mitigating governance challenges, including erratic spending and corruption.

Tax-based versus premium-based health financing models

Nepal is adopting both tax-funded and premium-based health financing models. The premium-based NHIP uses the family as the unit of enrollment and premium payment and is designed to reduce the OOP expenditure by providing services beyond tax-funded BHS [53, 55]. Evidence indicates that premium-based SHI models may increase OOP expenditures more than tax-funded programs in LMICs due to SHI’s higher implementation costs and more limited coverage [176, 177]. In LMICs, contributory premium-based health insurance schemes have not consistently proven to increase revenues to the health sector or help countries achieve universal health coverage [176], while transitions to government financing increase life expectancy and reduce catastrophic health expenditure incidence [177]. Instead, tax-funded systems promote equity through cross-subsidization and prioritize rural primary care, whereas SHI risks exacerbating urban-rural disparities unless paired with substantial subsidies [178].

While expanding coverage to the informal sector remains a major challenge for most LMICs, especially those relying on contributory systems, countries such as Bangladesh, Indonesia, Thailand, Vietnam and Ethiopia have successfully initiated their SHI programs by first covering civil servants and formal sector workers, leveraging their institutional ties to tax systems [179–181]. Nepal’s NHIP, however, was launched by first targeting households, which may have resulted in struggles to maintain sufficient coverage, achieve adequate risk pooling, and ensure long-term financial sustainability due to unpredictable revenue collection.

In Nepal’s context, tax-funded health financing models could be more equitable than premium-based SHI due to widespread poverty and a large informal workforce [174]. However, Nepal’s public health spending (<2% of GDP) is insufficient for sustainability without reforms like broadening the tax base or implementing earmarked health/sin taxes. Considering the size of the economy and public sector financing, reforming the current premium-based NHIP may not be feasible. Thus, a hybrid financing model that combines general taxation, payroll and member contributions, as well as health taxes and private or donor contributions, could be a viable option for Nepal. Thailand’s National Health Insurance offers a blueprint: These schemes are predominantly non-contributory, financed by general taxation; with higher-income individuals contributing progressively through the income tax system, ensuring equity in financing. Formal sector workers are covered under the contributory Social Security Scheme (SSS), which is funded by mandatory payroll contributions (1.5% of salary each from employees, employers, and the government). Informal sector workers, who constitute a significant portion of Thailand’s labor force, are covered under the Universal Coverage Scheme (UCS), with full cost government subsidies. Additional to this, charities and partnerships between public and private sectors are potential revenue sources for health [182, 183]. Nepal could draw on this model, as it has already introduced 2% payroll contributions (1% each from employees and employers). This should be designated as a health insurance tax at the base rate, supplemented by a progressive health insurance tax for high-income earners to pool funds for the sustainability of the NHIP. The government should also incorporate subsidized contributions for informal sector workers who represent 62% of Nepal’s labor force [168, 184]. Engaging private sector providers through Public-Private Partnerships (PPPs) can help further optimize resource allocation and service delivery.

Aligning health financing with disease burden

Nepal’s health financing remains misaligned with its evolving disease burden, with disproportionate focus on CMNN issues despite the increasing burden of NCDs and mental health conditions. While, publicly funded initiatives, largely target CMNN interventions at both facility and community levels, structural weaknesses such as staffing shortages, fragmented governance, and inadequate fiscal space [24, 157] have hindered the integration of NCD prevention and treatment within the broader health system. Additionally, systemic underfunding and weak multisectoral collaboration continue to impede efforts to address NCDs [7, 108, 185] preventing a holistic approach to health financing. Expanding fiscal space for NCD interventions—such as screening programs (e.g., cervical/breast cancer) and integrated PHC services—could reduce premature mortality, DALYs, and OOP expenses [153, 186–188]. However, implementation gaps persist, exemplified by the poorly executed BHS program, which delays early disease detection [1, 189, 190].

Nepal’s health system paradoxically prioritizes specialized hospitals over PHC, hindering NCD prevention [10]. This has created a situation where PHC facilities are being underutilized while tertiary hospitals are overwhelmed with patient flow. A “whole-of-society” approach is critical, one that includes integrating NCD services into PHC, expanding screening, and implementing community-based strategies (e.g., PEN interventions) to bridge gaps in early detection [153, 191, 192]. Other examples include ensuring at least one empaneled health facility per local government (410 of 753 lack such access) to provide health insurance services [32]. Redirecting resources to underserved populations is critical, addressing geographic and socioeconomic disparities through targeted subsidies and equitable resource allocation [108, 193]. Finally, multisectoral collaboration can potentially align policies with demographic shifts and leverage cost-effective interventions and global best practices [118, 136, 137]. Our analyses revealed that the UHC sub-index for service capacity and access and the index for NCDs remain weak, underscoring the need for targeted interventions. Expanding the scope of NCD care within the existing BHS package is essential to ensure comprehensive prevention, early diagnosis, and treatment. Strengthening the health workforce and adopting task-shifting strategies can enhance service capacity and improve accessibility, particularly in underserved areas.

NHIP reforms for addressing financial risk protection in healthcare

Over 50% of health expenditures in Nepal are financed through OOP, driven by NCD medication costs, insufficient public funding, and unregulated private-sector fees [10, 45, 141]. Catastrophic health expenditure affects 10.3% of households, disproportionately impacting low-income and rural populations [141]. Existing social protection schemes, such as the NHIP and the impoverished citizen treatment fund, prioritize treatment over prevention and suffer from restrictive benefit packages (e.g., an NPR 100,000 treatment cap) and low enrollment (<30% coverage) [14, 31, 32, 49]. Stark inequities persist across wealth quintiles, ethnicities, and provinces, exacerbated by elite preferential treatment (e.g., politicians’ medical funds) and fragmented risk-pooling mechanisms [52, 97, 193].

The NHIP faces structural issues such as coordination gaps between federal, provincial, and local governments, resource misallocation, infrastructure gaps, and workforce shortages that further hinder implementation [30, 32, 124]. Sustained reforms include improving intergovernmental coordination and enhancing funding efficiency—which remain critical to achieving UHC by 2030. To achieve this, the NHIP requires urgent reforms in expanding coverage caps, and enforcing mandatory enrollment to broaden risk pools [31, 32, 56, 47, 162, 194], replacing flat premiums with progressive tax contributions and subsidizing premiums for marginalized groups [30, 119, 130, 159]. A 20% co-payment is generally appropriate, but its determination should consider factors such as the premium amount, the total benefits received by the individual, a minimum premium for targeted groups, progressive premiums for accessing secondary and specialized services at government health institutions, and additional premiums for higher-level facilities [87]. Furthermore, digital transformation is vital to implement biometric enrollment, automated claims processing, and streamlined reimbursements to reduce fraud and improve transparency [30, 195, 196]. Governance autonomy is fundamental, and granting the HIB full operational independence from the MoHP strengthens strategic purchasing and accountability [30]. Service categorization (inpatient and outpatient caps), claims verification and evaluation to ensure clear claims, penalties for healthcare institutions or employees making false claims, a carry-forward system to prevent unnecessary treatments, integration of scattered programs to improve financial efficiency and eliminate redundancy, and promoting financial transparency and good governance could collectively enhance the NHIP’s effectiveness and accountability [87].

Maximizing risk pooling by minimizing fragmentation and duplication

Nepal’s social health protection system is characterized by fragmentation and duplication, primarily between the Health Insurance Program, SSF, and the free health care program alongside several other social protection schemes. These fragmentation presents challenges, including high administrative costs, inefficiencies in financial resource management, and complications in ensuring comprehensive coverage, strategic purchasing and redistribution of resources. Programs like the Free Health Care Program (tax-funded) and the Aama Program, which fund services already covered by NHIP, demonstrate duplication and overlap. Currently, multiple parallel schemes incur significant financial outlays: the Poor Citizens’ Treatment Fund spends NPR 6 billion annually on chronic diseases, the Aama Program costs NPR 3 billion, Social Service Units use NPR 2 billion, free treatment for children and seniors accounts for NPR 1 billion, dialysis and chronic disease treatments cost NPR 2 billion, and the SSF maternity scheme claims NPR 1.37 billion [87]. Clearly, such fragmented schemes are not effectively serving Nepal’s needs and require urgent reform. Merging these fragmented schemes into a single risk pool, or harmonizing them to ensure complementarity could enhance the redistributive capacity and strategic purchasing power for gains in efficiency and equity, but the success hinges on strong political will and legal reforms [11]. Global examples demonstrate the feasibility of such reforms. Thailand’s UCS established in 2002, merged the medical welfare scheme for low-income groups and contributory voluntary health card schemes for households, providing safety nets for populations attending primary-care units. Meanwhile, the tax-finance medical benefit scheme for public employees and contributory social security scheme for private employees operate in complementarity with UCS [182]. Similarly, in 2003, Korea consolidated its various risk pools into a single national health insurance system, streamlining both management and operational structures[197]. Additionally, several other LMICs, such as Ghana, Indonesia and Vietnam have also made efforts toward integrating or harmonizing their multiple programs to improve financial protection for their population[180]. Nepal can draw lessons from these experiences to develop a more integrated, sustainable, and equitable health financing model with broader risk pools.

Raising revenues for health.

Nepal’s public financing on health remains low, covering only 33% of the CHE, which places increased pressure on households due to high OOP spending [13]. Ensuring adequate fiscal space for health financing requires the country to diversify and expand its revenue sources. Domestic resource mobilization- through measures such as sin taxes on health-harming products and broadening the tax base- offers a viable approach to increasing health sector funding and combating NCDs [174, 198]. For instance, out of a total of 6,666,937 households (20% of which belong to poor families whose premiums can be covered by the Government of Nepal), with a contribution of NPR 10,000 per household and a progressive tax-based premium, the total premium collected amounts to NPR 66 billion [87]. The funding sources include NPR 16 billion from program integration, NPR 5 billion from local and provincial governments, NPR 5 billion from a sin tax, and 25% of the total expenditure covered by the HIB [87]. Many countries worldwide have implemented special taxes, funds, and budgets for health, with many directly allocating a portion of excise taxes on tobacco, alcohol, and other health-damaging items, as well as taxes from salaries and even lottery tickets, to fund health expenditures [87]. Countries like the Philippines have successfully leveraged sin taxes on tobacco, alcohol, sugar-sweetened beverages and other ultra-processed foods to generate billions of dollars since 2012 [199]. A significant portion of this revenue has been allocated to the health sector, contributing to a fivefold increase in subsidies for PhilHealth, the national health insurance scheme, thereby strengthening UHC [198, 200]. Similarly, Thailand, South Africa, and Vietnam have also improved sustainable health financing through dedicated taxation on harmful products [182, 201].

Resource allocation.

Funds should be directed towards high-impact areas like primary care and preventive services, focusing on vulnerable populations [29]. A shift from hospital-centric spending to decentralized primary healthcare is essential, particularly in rural areas, as a significant portion of care costs is also borne indirectly through expenses such as food, transportation, and loss of workdays while seeking care [10]. As seen in Brazil’s decentralized care model, data-driven tools, governance reforms focusing on PHC, and balancing equity with sustainability are key to improving access and capacity [202, 203]. Improving healthcare delivery requires enhancing efficiency, utilizing technology, prioritizing community-based approaches, and evaluating the long-term impact of policies and investments, while strengthening monitoring, accountability, governance, and transparency in healthcare spending [204]. Additionally, implementing performance-based financing, focusing on health promotion and preventive care, developing prevention-focused policies, and raising public awareness of health and well-being are crucial for sustainable progress and overall public health improvement. To support these efforts, allocating a larger proportion of the national budget to local governments is essential, as they play a central role in managing primary healthcare and implementing community-based health interventions.

Purchasing of health services.

Purchasing health services needs to be based on performance, quality, and cost-effectiveness rather than input-based budgeting. This requires shifting from input-based funding models, such as fixed salaries for health workers regardless of performance, to output- or outcome-based contracts, and bulk purchasing of commodities. Strategic purchasing models prioritize quality and cost-effectiveness, like Thailand’s performance-based contracting [197] or Brazil’s selective contracting [203]. The enrollment process and co-payment methods can help reduce treatment costs, while any unspent amount can be carried over to the next year, alleviating unnecessary treatment pressure; reinsurance can be arranged for serious patients, and resources could be effectively utilized by controlling expenditures and developing a system to scrutinize services and claims for enrollment or non-enrollment [87].

Implications of study for policy, program, and research

The study highlights key implications for policy and research, emphasizing the need for evidence-based decision-making, program improvements, and targeted interventions. It underscores the importance of addressing gaps in implementation, enhancing resource allocation, and fostering collaboration to achieve sustainable outcomes in policy and program effectiveness. Fig 7 presents the synthesized summary of implications of this study in policy, program, and research [Fig 7].

Download:

Fig 7. Summary of implications of study findings for policy and program.

https://doi.org/10.1371/journal.pone.0324880.g007

Strengths and limitations of the study

This review of Nepal’s health financing systems landscape utilized secondary data from multiple sources and was analyzed through a UHC lens as its guiding framework. The findings were reviewed and validated by health financing professionals in Nepal, enhancing the relevance and comprehensiveness of the overview. Despite these strengths, the study has limitations. Although expert validation was incorporated, the perspectives gathered may not fully represent the entire spectrum of stakeholders in Nepal’s health financing system. Consequently, the findings could be subject to bias based on the viewpoints of those consulted. Additionally, the quality and depth of secondary data sources varied, potentially influencing the interpretation of results. Nevertheless, this review offers valuable insights to inform future research and policy discussions on health financing in Nepal.

Conclusions

Nepal’s health financing policies are progressive and aligned with the aspiration of UHC, yet critical gaps persist in multiple dimensions. A disproportionate resource allocation to address the growing burden of NCDs and injuries, fragmented social health protection schemes, underfunding (as a percentage of GDP), and limited fiscal space hinders equitable access to quality care. The current health financing system remains inefficient and financially unsustainable, struggling to adapt to Nepal’s demographic and epidemiological shifts while maintaining adequate risk pools for viable schemes. To enable Nepal’s progress toward UHC, we propose the following policy reforms: 1) Enact legal reforms to merge existing social health protection schemes into a unified or fewer schemes, ensuring complementarity with the SSF to enhance efficiency in pooling and purchasing functions.2) Enhance domestic health financing – increase health funding (≥5% of GDP) by implementing a mix of revenue-raising strategies, including the universal enforcement of the existing 2% payroll contribution from employees and employers, adopting progressive health taxation for high-income earners, and earmarking sin taxes for health. 3) Reform the NHIP- make health insurance mandatory for formal sector employees while subsidizing coverage for informal sector workers; and strengthen NHIP operations through strategic purchasing, expanding the geographical coverage of empaneled health facilities, digitizing claims, broadening benefit packages, and integrating private providers with regulated pricing to reduce dropouts and enhance service access. 4) Improve equitable public financing and fiscal discipline– ensure equitable and needs-based allocation of health financing across federal, provincial, and local governments; and strengthen budget allocation and execution mechanisms to effectively respond to emerging epidemiological trends, including the increasing burden of NCDs and injuries, while maintaining adequate investment in CMNN care. Further research is needed to assess the feasibility of hybrid tax and premium based insurance models and their financial viability in Nepal. Additionally, studies exploring the optimization of strategic purchasing mechanisms, efficiency in health expenditure, and the role of digital health innovations in enhancing service delivery and financial protection are warranted.

Supporting information

S1 Table. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

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S2 Table. Search strategy.

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S3 Table. Selected documents and reports in the review.

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S1 Fig. Health financing policy trajectory of Nepal.

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S2 Fig. Health insurance coverage in Nepal.

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S3 Fig. Disease burden by age, Nepal (1990–2021).

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S4 Fig. Healthcare expenditures for political leaders and power elites during 2013–2022 in Nepal.

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Acknowledgments

The authors express gratitude to the presenters and panelists who shared their views and opinions during public forums and conferences organized by the Nepal Health Research Council (NHRC), including: The Eighth National Summit (April 11–12, 2022), specifically Plenary Session I: Strengthening Social Health Protection in Nepal: The Role of Evidence toward Universal Health Coverage (Speakers: Suresh Tiwari, Hema Bhatt, Shambhu Gyawali, and Swati Srivastava); The 9th National Summit 2023, Parallel Session 8: Evidence on Social Health Protection for Strong Institutions (speakers: Suresh Tiwari, Damodar Basaula, Shambhu Gyawali, Geha Nath Khanal, Bikesh Bajracharya, Mukesh Adhikari, Shiva Raj Adhikari, Madan Upadhyay, Laxmi Ghimire, Devi Prasad Prasai, and Dinesh Kafle); The 10th National Summit 2024, Plenary Session 1: Health Policy Reform and Financing (speakers: Shiva Raj Adhikari, Krishna Paudel, Guna Nidhi Sharma, Achyut Raj Pandey, Ravikant Mishra, and Pratik Khanal); A seminar organized by the National Planning Commission, Nepal (April 8, 2022), featuring Krishna Paudel and Shiva Raj Adhikari. This paper expands on a concept presented by the first author during a webinar organized by the Nepal Public Health Association (April 16, 2023). The authors also extend thanks to PhD candidates in health economics and financing—Umesh Prasad Bhusal (University of New South Wales, Australia), Geha Nath Khanal (Canterbury Christ Church University, UK), and Mukesh Adhikari (University of North Carolina, USA)—for reviewing the final manuscript.

References

1. Ministry of Health and Population. Basic Health Service Package In. Kathmandu: Ministry of Health and Population; 2019.
2. Khatri RB, Assefa Y, Durham J. Assessment of health system readiness for routine maternal and newborn health services in Nepal: Analysis of a nationally representative health facility survey, 2015. PLOS Glob Public Health. 2022;2(11):e0001298. pmid:36962692
- View Article
- PubMed/NCBI
- Google Scholar
3. MOHP WB, WHO, GIZ. Situation Analysis of Health Financing in Nepal. Kathmandu: Government of Nepal, Ministry of Health and Population; 2019.
4. Khanal GN, Khatri RB. Burden, prevention and control of tobacco consumption in Nepal: a narrative review of existing evidence. Int Health. 2021;13(2):110–21. pmid:32914846
- View Article
- PubMed/NCBI
- Google Scholar
5. LBD Double Burden of Malnutrition Collaborators. Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017. Nat Med. 2020;26(5):750–9. pmid:32313249
- View Article
- PubMed/NCBI
- Google Scholar
6. National Statistical Office. National Population and Housing Census 2021. Kathmandu: Government of Nepal, Office of the Prime Minister and Council of Ministers; 2023.
7. Nepal Health Research Council; Ministry of Health and Population, Institute for Health Metrics and Evaluation, Monitoring Evaluation and Operational Research: Nepal Burden of Disease 2019. A Country Report based on the 2019 Global Burden of Disease Study In. Kathmandu: NHRC, MoHP, IHME, and MEOR; 2021.
8. National Statistics Office. Nepal Living Standard Survey IV 2022/23. Kathmandu: National Statistics Office, Office of the Prime Minister and Council of Ministers Government of Nepal; 2024.
9. Gardner H, Miles G, Saleem A, Dunin-Borkowska A, Mohammad H, Puttick N, et al. Social determinants of health and the double burden of disease in Nepal: a secondary analysis. BMC Public Health. 2022;22(1):1567. pmid:35978424
- View Article
- PubMed/NCBI
- Google Scholar
10. Adhikari B, Mishra SR, Schwarz R. Transforming Nepal’s primary health care delivery system in global health era: addressing historical and current implementation challenges. Global Health. 2022;18(1):8. pmid:35101073
- View Article
- PubMed/NCBI
- Google Scholar
11. World Health Organization. The Global Health Observatory: Explore a world of health data. Geneva: WHO; 2025.
12. World health Organization. Health systems financing: the path to universal coverage. In. Geneva: world health Organization; 2010: 1-–128.
13. World Health Organization. Global Health Expenditure Database. In. Geneva: WHO; 2025.
14. 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 Res Policy Syst. 2023;21(1):7. pmid:36670433
- View Article
- PubMed/NCBI
- Google Scholar
15. Kuikel BS, Shrestha A, Xu DR, Shahi BB, Bhandari B, Mishra RK, et al. A critical analysis of health system in Nepal; Perspective’s based on COVID-19 response. Dialogues Health. 2023;3:100142. pmid:37325802
- View Article
- PubMed/NCBI
- Google Scholar
16. Bhandari D, Bi P, Sherchand JB, Dhimal M, Hanson-Easey S. Climate change and infectious disease research in Nepal: Are the available prerequisites supportive enough to researchers?. Acta Trop. 2020;204:105337. pmid:31930962
- View Article
- PubMed/NCBI
- Google Scholar
17. Shrestha N, Mishra SR, Ghimire S, Gyawali B, Marahatta SB, Maskey S, et al. Health System Preparedness for COVID-19 and Its Impacts on Frontline Health-Care Workers in Nepal: A Qualitative Study Among Frontline Health-Care Workers and Policy-Makers. Disaster Med Public Health Prep. 2021;:1–9. pmid:34140051
- View Article
- PubMed/NCBI
- Google Scholar
18. WHO South-East Asia Region. Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the WHO South-East Asia Region: 2022 update. In. South-East Asia Region: World Health Organization; 2022.
19. His majesty’s government. Constitution of the kingdom of Nepal 1990. Ministry of Law Justice and Parliamentary Affairs. 1990.
20. Ministry of Health and Population. National Health Policy‐1991. In. Kathmandu: Ministry of Health and Population; 1991.
21. Government of Nepal. The Interim Constitution of Nepal 2007. In. Kathmandu: Government of Nepal; 2007.
22. Secretariat of CA. Constitution of Nepal 2015. Kathmandu Constituent Assembly Secretariat. 2015.
23. Government of Nepal. Health Insurance Act. In. Kathmandu, Nepal Government of Nepal; 2017.
24. Ministry of Health and Population. Annual Health Report 2021/2022. In. Kathmandu: Ministry of Health and Population; 2022.
25. Ministry of Health and Population. Nepal Health Sector Strategic Plan, 2022-2030. In. Kathmandu Ministry of Health and Population; 2022.
26. Ministry of Health and Population. National Health Financing Strategy, 2023-2033. In. Kathmandu: Ministry of Health and Population; 2023.
27. Acharya D, Devkota B, Kreps GL. Does perceived susceptibility and severity of health problems serve as drivers for household enrolment in health insurance? A case study from Nepal. Int J Health Plann Manage. 2022;37(2):839–53. pmid:34719054
- View Article
- PubMed/NCBI
- Google Scholar
28. Acharya D, Sharma S, Bietsch K. Enrollment and associated factors of the national health insurance program of Nepal: Further analysis of the Nepal Demographic and Health Survey 2022. PLoS One. 2024;19(10):e0310324. pmid:39361628
- View Article
- PubMed/NCBI
- Google Scholar
29. Pandey AR. Health financing reforms in the quest for universal health coverage: Challenges and opportunities in the context of Nepal. J Glob Health. 2023;13:03021. pmid:37114984
- View Article
- PubMed/NCBI
- Google Scholar
30. Ayer R, Tiwari S, Jnawali SP, Dael R. A Study on Nepal’s National Health Insurance Program. In. Manila: Asian Development Bank; 2024.
31. International Labour Organization. Social health protection in Nepal. State of play and recommendations towards universal extension of coverage. In. Kathmandu: International Labour Organization; 2023.
32. International Labour Organization. Extending social protection for all in Nepal, an analysis of protection gaps. In. Kathmandu: International Labour Organization; 2023.
33. Ghimire S, Ghimire S, Singh DR, Sagtani RA, Paudel S. Factors influencing the utilisation of National health insurance program in urban areas of Nepal: Insights from qualitative study. PLOS Glob Public Health. 2024;4(7):e0003538. pmid:39058732
- View Article
- PubMed/NCBI
- Google Scholar
34. 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 Serv Res. 2023;23(1):159. pmid:36793046
- View Article
- PubMed/NCBI
- Google Scholar
35. Shrestha R, Shakya A, Khanal P, Khanal VK, Jha N, Nepal Gurung G, et al. User satisfaction with the National Health Insurance Program: A community-based survey from the Ilam district of Nepal. PLoS One. 2024;19(5):e0303045. pmid:38787905
- View Article
- PubMed/NCBI
- Google Scholar
36. Pokharel S, Acharya SR, Pahari S, Moon DH, Shin YC. Utilization of Healthcare Services & Healthcare Expenditure Patterns in the Rural Households of Nepal. APJHM. 2021;16(1):86–94.
- View Article
- Google Scholar
37. Acharya D, Thapa KB, Sharma B, Rana MS. Causes of dropout from health insurance program: An experience from Lumbini Province, Nepal. Dialogues Health. 2023;3:100150. pmid:38515800
- View Article
- PubMed/NCBI
- Google Scholar
38. Peters MDJ, Marnie C, Colquhoun H, Garritty CM, Hempel S, Horsley T, et al. Scoping reviews: reinforcing and advancing the methodology and application. Syst Rev. 2021;10(1):263. pmid:34625095
- View Article
- PubMed/NCBI
- Google Scholar
39. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005;8(1):19–32.
- View Article
- Google Scholar
40. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. pmid:20854677
- View Article
- PubMed/NCBI
- Google Scholar
41. World Health Organization. Making fair choices on the path to universal health coverage: Final report of the WHO Consultative Group on Equity and Universal Health Coverage. In. Geneva: World Health Organization; 2014.
42. World Health Organization. Universal health coverage and health financing. In. vol. 18. Geneva: World Health Organization; 2019.
43. MOHP and NHSSP. Review of national health policy 1991. In. Kathmandu: MOHP and NHSSP; 2012.
44. Nepal Go. Social Health Security Development Board Development Board (formation) Order 2014 In. Kathmandu: Government of Nepal; 2014.
45. Ministry of Health and Population. Progress of health and population sector 2023/24. In. Kathmandu: Ministry of Health and Population; 2024.
46. Health Insurance Board. Acts, rules, directives and procedures. In. Kathmandu: Health Insurance Board; 2024.
47. Gurung GB, Panza A. Predictors of annual membership renewal to increase the sustainability of the Nepal National Health Insurance program: A cross-sectional survey. PLOS Glob Public Health. 2022;2(4):e0000201. pmid:36962197
- View Article
- PubMed/NCBI
- Google Scholar
48. Health Insurance Borard. Operational guideline for implementation of co-payment system in the health insurance program, 2080 In. Kathmandu: Health Insurance Board; 2024.
49. Ministry of Health and Population. Annual Health Report 2022/2023. In. Kathmandu: Ministry of Health and Population; 2024.
50. Health Insurance Borard. Accreditation guideline for service providing facilities, 2024. In. Kathmandu: Health Insurance Board; 2024.
51. Health Insurance Board. Annual report 2022/23: factsheet and executive summary. In. Kathmandu: Health Insurance Board; 2024.
52. Government of Nepal. Public Health Service Act. In. Kathmandu, Nepal: Government of Nepal; 2018.
53. Ministry of Health and Population. Standard Treatment Protocol (STP) For Basic Health Services (BHS) Package 2078. In. Kathmandu: Ministry of Health and Population; 2020.
54. Ministry of Health and Population. Standard Treatment Protocol of Emergency Health Service Package. In. Kathmandu: Ministry of Health and Population; 2020.
55. Poudel P, Khatri R, Bhatt L, Thapa P, Mishra RK, Tuladhar S, Panahi E: Baseline Status of Basic Health Service Delivery, 2022 Nepal DHS and 2021 Nepal HFS. DHS Further Analysis Reports No. 157. In. Kathmandu Rockville, Maryland, USA: ICF; and Kathmandu, Nepal: MoHP; 2024.
56. Government of Nepal. Health Insurance Regulation. In. Kathmandu, Nepal: Government of Nepal; 2019.
57. Ministry of Health and Population. National Health Policy 1991. In. Kathmandu: Ministry of Health and Population; 1991.
58. Stoermer M, Fuerst F, Rijal K, Bhandari R, Nogier C, Gautam GS, et al. Review of community-based health insurance initiatives in Nepal. Kathmandu: Deutsche Gesellschaft für internationale Zusammenarbeit (GIZ) Gmb; 2012.
59. Pandey S, Daley A. Free delivery care and supply-side incentives in Nepal’s poorest districts: the effect on prenatal care and neonatal tetanus vaccinations. Journal of Development Effectiveness. 2020;13(1):100–15.
- View Article
- Google Scholar
60. Witter S, Khadka S, Nath H, Tiwari S. The national free delivery policy in Nepal: early evidence of its effects on health facilities. Health Policy Plan. 2011;26 Suppl 2:ii84-91. pmid:22027923
- View Article
- PubMed/NCBI
- Google Scholar
61. Ministry of Health and Population. National Health Policy 2014. In. Kathmandu: Ministry of Health and Population; 2014.
62. MoH and NHSSP. Budget Analysis of Ministry of Health FY 2017/18. In. Kathmandu: Ministry of Health and Nepal Health Sector Support Programme; 2018.
63. Uprety S, Lamichhane B. Health budgeting and financing in nepal: policy perspectives. Health Policy. 2016.
- View Article
- Google Scholar
64. Ministry of Health and Population. National Health Policy 2019. In. Kathmandu: Ministry of Health and Population; 2019.
65. Ministry of Health and Population. Directives, Guidelines and Manuals. In. Kathmandu: Ministry of Health and Population 2021.
66. NHRC. Towards Universal Health Coverage: Addressing Financial Hardship and Improving Access to Healthcare in Nepal (Policy brief). Kathmandu: Nepal Health Research Council; 2022.
67. Wasti SP, van Teijlingen E, Rushton S, Subedi M, Simkhada P, Balen J, et al. Overcoming the challenges facing Nepal’s health system during federalisation: an analysis of health system building blocks. Health Res Policy Syst. 2023;21(1):117. pmid:37919769
- View Article
- PubMed/NCBI
- Google Scholar
68. Ministry of Health and Population. National Health Insurance Policy 2014. In. Kathmandu: Ministry of Health and Population; 2014.
69. Ministry of Health and Population. Nepal Health Sector Strategy, 2010-2015. In. Kathmandu: Nepal Government of Nepal; 2010.
70. Ministry of Health and Population. Nepal Health Sector Strategy, 2015-2022. In. Kathmandu: Nepal Government of Nepal; 2015.
71. Government of Nepal. Budget Details: Red Book (Fiscal year 2010/11) In. Kathmandu: Ministry of Finance; 2014.
72. Ministry of Health and Population. Strategic Review of Social Audit in the Health Sector. Kathmandu: Ministry of Health and Population; 2019.
73. Ministry of Health and Population. Progress Report on Financial Management In Nepal’s Health Sector. Kathmandu: Ministry of Health and Population; 2014.
74. Daniels D, Ghimire K, Thapa P, Réveillon M, Pathak DR, Baral K, et al. Nepal health sector programme II mid-term review. Kathmandu: Ministry of Health. 2013.
75. NHSSP. Innovative Good Practices in Nepal’s Health Sector. In. Kathmandu: NHSSP; 2016.
76. Ministry of Health and Population. Annual Health Report 2016/17. In. Kathmandu: Ministry of Health and Population; 2018.
77. Ministry of Health and Population. Nepal National Health Accounts 2015/16 report In. Kathmandu: Ministry of Health and Population; 2018.
78. Employee Provident Fund. Annual Report of Employee Provident Fund. Lalitpur: Employee Provident Fund, Government of Nepal; 2020.
79. 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 Res Policy Syst. 2023;21(1):7. pmid:36670433
- View Article
- PubMed/NCBI
- Google Scholar
80. Ministry of Health and Population. Partnership, Alignment and Harmonisation in the Health Sector. Kathmandu: Ministry of Health and Population; 2015.
81. Ministry of Health and Population. Nepal Health Sector Strategy (NHSS) Mid Term Review Report. Kathmandu: Ministry of Health and Population; 2018.
82. Khanal P, Mishra SR. Federal governance and the undying parade for universal health coverage in Nepal. Health Prospect. 2019;18(1):1–3.
- View Article
- Google Scholar
83. Aryal KK. Free Basic Healthcare in Nepal: Can the Dream be Turned into Reality in the Pursuit of Universal Health Coverage?. J Nepal Health Res Counc. 2023;21(1):i–iii. pmid:37742139
- View Article
- PubMed/NCBI
- Google Scholar
84. Nepal Health Research Council. Towards Universal Health Coverage: Addressing Financial Hardship and Improv ing Access to Healthcare in Nepal (Policy brief). Kathmandu: Nepal Health Research Council; 2022.
85. Ministry of Health and Population. Nepal Health Sector Support Programme 2017-2022 Achievements, Learning and Future Approaches: Results Brief. Kathmandu: Ministry of Health and Population; 2022.
86. Ministry of Health and Population, NHSSP, Options. Nepal Health Sector Support Programme (NHSSP 3) – No Cost Extension. Kathmandu: Ministry of Health and Population; 2023.
87. Health Insurance Reform Proposal Task Force. Health Insurance Reform Proposal Task Force Report, 2081 (2025), Nepali version In. Kathmandu: Ministry of Health and Population; 2025.
88. Ministry of Health and Population. Medical treatment of deprived citizens. vol. 2025. Kathmandu: Ministry of Health and Population; 2025.
89. Social Security Fund. Annual Report 2023/2024. Kathmandu: Social Security Fund; 2024.
90. Employee Provident Fund. Annual Report of Employee Provident Fund 2022/2023. Lalitpur: Employee Provident Fund, Government of Nepal; 2024.
91. Employees Providednt Fund. Healthcare Plan. vol. 2024. Kathmandu: Employees Providednt Fund; 2024.
92. Ministry of Health and Population. Social Service Unit Establishment and Operational Guidelines. Kathmandu: Ministry of Health and Population; 2020.
93. Ministry of Health and Population. Senior Citizen Health Service Operation Guideline 2077 (2021). In. Kathmandu: Ministry of Health and Population; 2021.
94. Ministry of Health and Population. Nepal Health Sector Strategy, 2004-2009. In. Kathmandu: Nepal Government of Nepal; 2005.
95. Ministry of Health and Population, New ERA, ICF. 2022 Nepal Demographic and Health Survey Key Findings. Kathmandu: Ministry of Health and Population; 2023.
96. National Centre for AIDS and STD Control. National HIV Factsheet. Kathmandu: Ministry of Health and Population; 2023.
97. Government of Nepal. Public Health Service Regulation 2020 (unofficial translation). Kathmandu: Ministry of Health and Population; 2020.
98. Central Bureau of Statistics (CBS). Nepal Multiple Indicator Cluster Survey 2019,Survey Findings Report. Kathmandu: Central Bureau of Statistics and UNICEF Nepal; 2020.
99. Social Security Fund. Daily Summary Report as of 09 Jan 2024. Kathmandu: Social Security Fund; 2024.
100. Social Security Fund. Daily summary report as of 7 October 2023. Kathmandu: Social Security Fund, Government of Nepal; 2023.
101. Ministry of Health and Population. Geriatrics (Senior Citizens) Health Service Operational Guideline- 2023/24. Kathmandu: Ministry of Health and Population; 2024.
102. Gartoulla P, Liabsuetrakul T, Chongsuvivatwong V, McNeil E. Ability to pay and impoverishment among women who give birth at a University Hospital in Kathmandu, Nepal. Glob Public Health. 2012;7(10):1145–56. pmid:23083138
- View Article
- PubMed/NCBI
- Google Scholar
103. Ensor T, Bhatt H, Tiwari S. Incentivizing universal safe delivery in Nepal: 10 years of experience. Health Policy Plan. 2017;32(8):1185–92. pmid:28591799
- View Article
- PubMed/NCBI
- Google Scholar
104. Rana K, Chimoriya R, Haque NB, Piya MK, Chimoriya R, Ekholuenetale M, et al. Prevalence and Correlates of Underweight among Women of Reproductive Age in Nepal: A Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(18):11737. pmid:36142012
- View Article
- PubMed/NCBI
- Google Scholar
105. World Health Organization. Tracking universal health coverage: 2023 global monitoring report. In. Geneva: World Health Organization; 2023.
106. World Health Organization. Tracking Universal Health Coverage: global monitoring report. In. Geneva: World Health Organization and International Bank for Reconstruction and Development/The World Bank; 2021.
107. Atreya A, Shrestha DB, Budhathoki P, Nepal S. Epidemiology of Road Traffic Accidents in Nepal from 2009/10 to 2019/20: A 10 Year Study. J Nepal Health Res Counc. 2021;19(2):343–8. pmid:34601528
- View Article
- PubMed/NCBI
- Google Scholar
108. Sapkota BP, Baral KP, Berger U, Parhofer KG, Rehfuess EA. Health sector readiness for the prevention and control of non-communicable diseases: A multi-method qualitative assessment in Nepal. PLoS One. 2022;17(9):e0272361. pmid:36178897
- View Article
- PubMed/NCBI
- Google Scholar
109. Adhikari B, Pandey A, Lamichhane B, KC S, Joshi D, Regmi S, et al. Non-communicable disease service readiness in Nepal: a further analysis of Nepal health facility survey-2021. medRxiv. 2023;2023:2023.2002.2007.23285512.
- View Article
- Google Scholar
110. Adhikari TB, Acharya P, Högman M, Neupane D, Karki A, Drews A, et al. Prevalence of Chronic Obstructive Pulmonary Disease and its Associated Factors in Nepal: Findings from a Community-based Household Survey. Int J Chron Obstruct Pulmon Dis. 2020;15:2319–31. pmid:33061350
- View Article
- PubMed/NCBI
- Google Scholar
111. Acharya KP, Wilson RT. Antimicrobial Resistance in Nepal. Front Med (Lausanne). 2019;6:105. pmid:31179281
- View Article
- PubMed/NCBI
- Google Scholar
112. Ministry of Health and Population. A review of studies on Nepal’s national free health care programme. Kathmandu: Primary Health Care Revitalization Division, Department of Health Services; 2013.
113. Khanal GN. Conditional cash transfer policies in maternal health service utilization in Nepal: Analysis of safe delivery incentive program (Aama Surakshya Karyakram) using Kingdon’s multiple streams framework. Int J Health Plann Manage. 2019;34(1):e131–41. pmid:30370556
- View Article
- PubMed/NCBI
- Google Scholar
114. Acharya S, Ghimire S, Jeffers EM, Shrestha N. Health Care Utilization and Health Care Expenditure of Nepali Older Adults. Front Public Health. 2019;7:24. pmid:30828573
- View Article
- PubMed/NCBI
- Google Scholar
115. Karmacharya I, Ghimire S, Bhujel K, Shrestha Dhauvadel A, Adhikari S, Baral S, et al. Health Services Utilization among Older Adults in Pokhara Metropolitan City. J Aging Soc Policy. 2022;34(4):568–87. pmid:33433265
- View Article
- PubMed/NCBI
- Google Scholar
116. Ranabhat CL, Subedi R, Karn S. Status and determinants of enrollment and dropout of health insurance in Nepal: an explorative study. Cost Eff Resour Alloc. 2020;18:40. pmid:33013204
- View Article
- PubMed/NCBI
- Google Scholar
117. Ranabhat CL, Kim C-B, Singh DR, Park MB. A Comparative Study on Outcome of Government and Co-Operative Community-Based Health Insurance in Nepal. Front Public Health. 2017;5:250. pmid:29062833
- View Article
- PubMed/NCBI
- Google Scholar
118. Pokharel R, Silwal P. Social health insurance in nepal: A health system departure toward the universal health coverage. Int J Health Plann Manage. 2018.
- View Article
- Google Scholar
119. Kandel N. Nepal Health Insurance Bill: Possible Challenges and Way Forwards. JNMA J Nepal Med Assoc. 2018;56(210):633–9. pmid:30376011
- View Article
- PubMed/NCBI
- Google Scholar
120. Sharma P, Yadav DK, Shrestha N, Ghimire P. Dropout Analysis of a National Social Health Insurance Program at Pokhara Metropolitan City, Kaski, Nepal. Int J Health Policy Manag. 2022;11(11):2476–88. pmid:35042322
- View Article
- PubMed/NCBI
- Google Scholar
121. Adhikari R, Shah R, Khanal V. Older people’s challenges accessing health services in central Nepal: a qualitative study using the domain of access framework. BMC Health Serv Res. 2024;24(1):1273. pmid:39443984
- View Article
- PubMed/NCBI
- Google Scholar
122. Ministry of Health and Population. Annual report 2022/23: factsheet and executive summary. Kathmandu: Ministry of Health and Population; 2024.
123. Ministry of Health and Population. Annual Health Report 2020/21. Kathmandu: Ministry of Health and Population; 2020.
124. Paudel A: Work on 400 basic hospitals in local units may not start next fiscal year. In: The Kathmandu Post. Kathmandu: Kantipur Media Pvt Ltd; 2023.
125. Ministry of Health and Population. National joint annual review report. Ramshahpath, Kathmandu Nepal: Ministry of Health and Population; 2024.
126. Ghimire P, Sapkota VP, Poudyal AK. Factors Associated with Enrolment of Households in Nepal’s National Health Insurance Program. Int J Health Policy Manag. 2019;8(11):636–45. pmid:31779289
- View Article
- PubMed/NCBI
- Google Scholar
127. Bhusal UP, Sapkota VP. Predictors of health insurance enrolment and wealth-related inequality in Nepal: evidence from Multiple Indicator Cluster Survey (MICS) 2019. BMJ Open. 2021;11(11):e050922. pmid:34836898
- View Article
- PubMed/NCBI
- Google Scholar
128. Paudel DR. Factors Affecting Enrollment in Government Health Insurance Program in Kailali District. J Nepal Health Res Counc. 2019;17(3):388–93. pmid:31735937
- View Article
- PubMed/NCBI
- Google Scholar
129. Adhikari N, Wagle RR, Adhikari DR, Thapa P, Adhikari M. Factors Affecting Enrolment in the Community Based Health Insurance Scheme of Chandranigahapur Hospital of Rautahat District. J Nepal Health Res Counc. 2019;16(41):378–84. pmid:30739922
- View Article
- PubMed/NCBI
- Google Scholar
130. Gurung GB, Panza A. Implementation bottlenecks of the National Health Insurance program in Nepal: Paving the path towards Universal Health Coverage: A qualitative study. Int J Health Plann Manage. 2022;37(1):171–88. pmid:34505317
- View Article
- PubMed/NCBI
- Google Scholar
131. Mishra SR, Khanal P, Karki DK, Kallestrup P, Enemark U. National health insurance policy in Nepal: challenges for implementation. Glob Health Action. 2015;8:28763. pmid:26300556
- View Article
- PubMed/NCBI
- Google Scholar
132. Our World in Data. Country profile:Nepal. In. Oxford: Oxford Martin School, University of Oxford; 2023.
133. IQAir. Air quality in Nepal Air quality in Nepal In.; 2022.
134. Ministry of Health and Population. Nepal National Health Accounts 2018/19 – 2019/20. Kathmandu: Ministry of Health and Population; 2023.
135. Sapkota VP, Bhusal UP, Adhikari GP. Occupational and geographical differentials in financial protection against healthcare out-of-pocket payments in Nepal: Evidence for universal health coverage. PLoS One. 2023;18(1):e0280840. pmid:36706091
- View Article
- PubMed/NCBI
- Google Scholar
136. Swe KT, Rahman MM, Rahman MS, Saito E, Abe SK, Gilmour S, et al. Cost and economic burden of illness over 15 years in Nepal: A comparative analysis. PLoS One. 2018;13(4):e0194564. pmid:29617393
- View Article
- PubMed/NCBI
- Google Scholar
137. Pyakurel P, Tripathy JP, Oo MM, Acharya B, Pyakurel U, Singh SB, et al. Catastrophic health expenditure among industrial workers in a large-scale industry in Nepal, 2017: a cross-sectional study. BMJ Open. 2018;8(11):e022002. pmid:30446573
- View Article
- PubMed/NCBI
- Google Scholar
138. Saito E, Gilmour S, Rahman MM, Gautam GS, Shrestha PK, Shibuya K. Catastrophic household expenditure on health in Nepal: a cross-sectional survey. Bull World Health Organ. 2014;92(10):760–7. pmid:25378730
- View Article
- PubMed/NCBI
- Google Scholar
139. Rai S, Gautam S, Yadav GK, Niraula SR, Singh SB, Rai R, et al. Catastrophic health expenditure on chronic non-communicable diseases among elder population: A cross-sectional study from a sub-metropolitan city of Eastern Nepal. PLoS One. 2022;17(12):e0279212. pmid:36512634
- View Article
- PubMed/NCBI
- Google Scholar
140. Thapa AK, Pandey AR. National and Provincial Estimates of Catastrophic Health Expenditure and its Determinants in Nepal. J Nepal Health Res Counc. 2021;18(4):741–6. pmid:33510521
- View Article
- PubMed/NCBI
- Google Scholar
141. Ghimire M, Ayer R, Kondo M. Cumulative incidence, distribution, and determinants of catastrophic health expenditure in Nepal: results from the living standards survey. Int J Equity Health. 2018;17(1):23. pmid:29444686
- View Article
- PubMed/NCBI
- Google Scholar
142. Khatiwoda SR, Dhungana RR, Sapkota VP, Singh S. Estimating the Direct Cost of Cancer in Nepal: A Cross-Sectional Study in a Tertiary Cancer Hospital. Front Public Health. 2019;7:160. pmid:31294011
- View Article
- PubMed/NCBI
- Google Scholar
143. Shrestha A, Parajuli SB, Aryal A, Shrestha A, Maharjan R, Jha N, et al. National Needs Assessment of Health Information System to Address Cardiovascular Diseases in Nepal: A Mixed Method Study. Kathmandu Univ Med J (KUMJ). 2021;19(75):58–67. pmid:35526137
- View Article
- PubMed/NCBI
- Google Scholar
144. Dulal RK, Magar A, Karki SD, Khatiwada D, Hamal PK. Analysis of Health Sector Budget of Nepal. JNMA J Nepal Med Assoc. 2014;52(194):811–21. pmid:26905710
- View Article
- PubMed/NCBI
- Google Scholar
145. Gupta I, Chowdhury S. Correlates of out-of-pocket spending on health in Nepal: implications for policy. WHO South East Asia J Public Health. 2014;3(3):238–46. pmid:28612808
- View Article
- PubMed/NCBI
- Google Scholar
146. Evidence on social health protection for strong institutions. In: 9th National Virtual Summit of Health and Population Scientists in Nepal. Kathmandu, Nepal: Nepal Health Research Council. 2023.
147. MoHP and UKaid/NHSSP. Budget Analysis of Health Sector In. Kathmandu: Ministry of Health and Population and UKaid/Nepal Health Sector Support Programme; 2020.
148. Institute for Health Metrics and Evaluation. Nepal, All-cause, Spending as % of GDP, 1995-2024. Seatle: Institute for Health Metrics and Evaluation; 2023.
149. United Nations International Children’s Emergency Fund. Budget Brief Updates. Health Budget: FY 2021/22 In. Kathmandu: United Nations International Children’s Emergency Fund; 2021.
150. Ministry of Health and Population. Nepal National Health Accounts 2017/18 report In. Kathmandu: Ministry of Health and Population; 2022.
151. Ministry of Health and Population. Nepal National Health Accounts 2016/17. Kathmandu: Ministry of Health and Population; 2019.
152. Ministry of Health and Population. Nepal National Health Accounts 2017/18. Kathmandu: Ministry of Health and Population; 2022.
153. Pandey A, Baral P, Shrestha A. Non-communicable diseases and their risk factors: panel discussion on its interventions in Nepal. Webinar and panel discussion organised by Nepal Public Health Association. Kathmandu, Nepal: Nepal Public Health Association. 2023.
154. Ministry of Health and Population, NHSSP. Health Sector Budget Analysis: First Five Years of Federalism. In. Kathmandu: Ministry of Health and Population, BEK/Nepal Health Sector Support Programme; 2022.
155. Ministry of Health and Population, Nepal Health Sector Support Programme. Budget Analysis of Ministry of Health FY 2021/22. In. Kathmandu: Ministry of Health and Population, Nepal Health Sector Support Programme; 2022.
156. Gyanwali S. Status, challenges and way forward for Health Insurance Programme in Nepal (Inv Talk). In: 9th National Virtual Summit of Health and Population Scientists in Nepal. Kathmandu, Nepal; 2023.
157. Shrestha A, Maharjan R, Karmacharya BM, Bajracharya S, Jha N, Shrestha S, et al. Health system gaps in cardiovascular disease prevention and management in Nepal. BMC Health Serv Res. 2021;21(1):655. pmid:34225714
- View Article
- PubMed/NCBI
- Google Scholar
158. Acharya D, Devkota B, Gautam K, Bhattarai R. Association of information, education, and communication with enrolment in health insurance: a case of Nepal. Arch Public Health. 2020;78(1):135. pmid:33317622
- View Article
- PubMed/NCBI
- Google Scholar
159. Ranabhat CL, Kim C-B, Singh A, Acharya D, Pathak K, Sharma B, et al. Challenges and opportunities towards the road of universal health coverage (UHC) in Nepal: a systematic review. Arch Public Health. 2019;77:5. pmid:30740223
- View Article
- PubMed/NCBI
- Google Scholar
160. Gyawali B, Khanal P, Mishra SR, van Teijlingen E, Wolf Meyrowitsch D. Building Strong Primary Health Care to Tackle the Growing Burden of Non-Communicable Diseases in Nepal. Glob Health Action. 2020;13(1):1788262. pmid:32696724
- View Article
- PubMed/NCBI
- Google Scholar
161. Gartaula P, Neupane S, Thakur DN, Sangroula RK. Out of pocket Expenditure on Health Service Delivery at a Tertiary Care Women’s Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2020;58(232):1024–7. pmid:34506383
- View Article
- PubMed/NCBI
- Google Scholar
162. Shah S, Jha N, Khanal VK, Nepal Gurung G, Sharma B, Shrestha M. Utilization of social health security scheme among the households of Illam district, Nepal. PLoS One. 2022;17(5):e0265993. pmid:35536839
- View Article
- PubMed/NCBI
- Google Scholar
163. Ministry of Home Affairs. Standards Related toTreatment Expenses, Relief, and Financial Assistance, 2077 In. Kathmandu: Ministry of Home Affairs, Government of Nepal; 2019.
164. Basnet MB. Access to the poor’s money, who took how much (list) (Nepali). In: Himal Khabar Kathmandu; 2023.
165. Reporter Swasthya Khabar Pratika. Government’s decision to bear former Prime Minister Khanal’s medical expenses, violating the provisions of the Act. In: Swasthya Khabar Pratika. Kathmandu; 2021.
166. Ministry of Health and Population. Working procedure related to citizen relief, compensation and financial support. Kathmandu: Ministry of Health and Population; 2016.
167. World Bank. GDP (current US$) - Nepal. In. Online: The World Bank data; 2024.
168. Adhikari SR, Raut NK: Size of informal economy in Nepal. In. Kathmandu: Tribhuvan University, Nepal Rastra Bank; 2024.
169. Nepal Rastra Bank. Annual report FY 2022/23. In. Kathmandu: Nepal Rastra Bank,Economic Research Department Publication Division; 2023.
170. Bahl RW, Timofeev A, Yilmaz S. Implementing federalism: The case of Nepal. Public Budgeting & Finance. 2022;42(3):23–40.
- View Article
- Google Scholar
171. Ministry of Finance Budget speech 2024/25. In. Kathmandu: Ministry of Finance; 2024.
172. Sapkota T, Houkes I, Bosma H. Vicious cycle of chronic disease and poverty: a qualitative study in present day Nepal. Int Health. 2021;13(1):30–8. pmid:32352145
- View Article
- PubMed/NCBI
- Google Scholar
173. Flessa S. Sector-Wide Approach (SWAp) in Healthcare-A Mixed-Methods Assessment of Health SWAps in Nepal and Bangladesh. Int J Environ Res Public Health. 2024;21(12):1682. pmid:39767523
- View Article
- PubMed/NCBI
- Google Scholar
174. Witter S, Bertone MP, Baral S, Gautam G, Pratap SKC, Pholpark A, et al. Political economy analysis of health financing reforms in times of crisis: findings from three case studies in south-east Asia. Int J Equity Health. 2025;24(1):34. pmid:39901272
- View Article
- PubMed/NCBI
- Google Scholar
175. Ghimire DK. Corruption and underdevelopment in Nepal: a content analysis. Dhaulagiri J Sociol Anthropol. 2022;16.
- View Article
- Google Scholar
176. Yazbeck AS, Soucat AL, Tandon A, Cashin C, Kutzin J, Watson J, et al. Addiction to a bad idea, especially in low- and middle-income countries: Contributory health insurance. Soc Sci Med. 2023;320:115168. pmid:36822716
- View Article
- PubMed/NCBI
- Google Scholar
177. Gabani J, Mazumdar S, Suhrcke M. The effect of health financing systems on health system outcomes: A cross-country panel analysis. Health Econ. 2023;32(3):574–619. pmid:36480236
- View Article
- PubMed/NCBI
- Google Scholar
178. Mathauer I, Vinyals Torres L, Kutzin J, Jakab M, Hanson K. Pooling financial resources for universal health coverage: options for reform. Bull World Health Organ. 2020;98(2):132–9. pmid:32015584
- View Article
- PubMed/NCBI
- Google Scholar
179. Joarder T, Chaudhury TZ, Mannan I. Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions. Psyche (Camb Mass). 2019;2019:4954095. pmid:33281233
- View Article
- PubMed/NCBI
- Google Scholar
180. Maeda A, Araujo E, Cashin C, Harris J, Ikegami N, Reich M. Universal health coverage for inclusive and sustainable development: a synthesis of 11 country case studies. World Bank Publications. 2014.
181. Nundy M, Bhatt P. Health System in the Republic of Indonesia: Reforms, Transformations, and Challenges (CSEP Working Paper 43). Centre for Social and Economic Progress; 2022.
182. Sumriddetchkajorn K, Shimazaki K, Ono T, Kusaba T, Sato K, Kobayashi N. Universal health coverage and primary care, Thailand. Bull World Health Organ. 2019;97(6):415–22. pmid:31210679
- View Article
- PubMed/NCBI
- Google Scholar
183. Jabeen R, Rabbani U, Abbas N. Financing mechanisms applied for successful Universal Health Coverage in Malaysia, Thailand and Singapore-lessons for Pakistan. 2021.
184. Adhikari DB. Informal Economy and Poverty in Urban Nepal. Economic Journal of Nepal. 2018;41(3–4):12–24.
- View Article
- Google Scholar
185. Deshpande A, Miller-Petrie MK, Lindstedt PA, Baumann MM, Johnson KB, Blacker BF, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahpour I: Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000–17. The Lancet Global Health 2020, 8(9):e1162-e1185.
- View Article
- Google Scholar
186. Otieno E, Seeiso T, Businge J, Kimera G, Sempira E. Achieving universal health coverage inSub-Saharan Africa through the reformation of mental health financing. GHES. 2024;0(0):3700.
- View Article
- Google Scholar
187. Mandal R, Basu P. Cancer screening and early diagnosis in low and middle income countries : Current situation and future perspectives. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018;61(12):1505–12. pmid:30353287
- View Article
- PubMed/NCBI
- Google Scholar
188. Nugent R, Bertram MY, Jan S, Niessen LW, Sassi F, Jamison DT, et al. Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals. Lancet. 2018;391(10134):2029–35. pmid:29627167
- View Article
- PubMed/NCBI
- Google Scholar
189. Local Burden of Disease HIV Collaborators. Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems. BMC Med. 2021;19(1):4. pmid:33413343
- View Article
- PubMed/NCBI
- Google Scholar
190. Dhimal M, Dhimal ML, Dahal S, Shrestha MP, Gyanwali P, Shao R, et al. Barriers and facilitators to the implementation of a national multisectoral action plan for the prevention and control of noncommunicable diseases in Nepal: perspectives of stakeholders. Glob Health Action. 2021;14(1):1963069. pmid:34448675
- View Article
- PubMed/NCBI
- Google Scholar
191. Kumar A, Schwarz D, Acharya B, Agrawal P, Aryal A, Choudhury N, et al. Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal. BMJ Glob Health. 2019;4(2):e001343. pmid:31139453
- View Article
- PubMed/NCBI
- Google Scholar
192. Freebairn L, Song YJC, Occhipinti J-A, Huntley S, Dudgeon P, Robotham J, et al. Applying systems approaches to stakeholder and community engagement and knowledge mobilisation in youth mental health system modelling. Int J Ment Health Syst. 2022;16(1):20. pmid:35462553
- View Article
- PubMed/NCBI
- Google Scholar
193. Gupta I, Chowdhury S. Correlates of out-of-pocket spending on health in Nepal: implications for policy. WHO South East Asia J Public Health. 2014;3(3):238–46. pmid:28612808
- View Article
- PubMed/NCBI
- Google Scholar
194. Sapkota VP, Bhusal UP. Governance and Purchasing Function under Social Health Insurance in Nepal: Looking Back and Moving Forward. J Nepal Health Res Counc. 2017;15(1):85–7. pmid:28714499
- View Article
- PubMed/NCBI
- Google Scholar
195. Oranje M, Mathauer I. Exploring the effects of digital technologies in health financing for universal health coverage: a synthesis of country experiences and lessons. Oxf Open Digit Health. 2024;2:oqae016. pmid:40230965
- View Article
- PubMed/NCBI
- Google Scholar
196. Wilson D, Sheikh A, Görgens M, Ward K, World Bank. Technology and Universal Health Coverage: Examining the role of digital health. J Glob Health. 2021;11:16006. pmid:34912559
- View Article
- PubMed/NCBI
- Google Scholar
197. Bae G, Kang M, Reich MR. The Consolidation of Risk Pools in the National Health Insurance Program of the Republic of Korea: Analysis of the Political Processes. Health Syst Reform. 2024;10(1):2375101. pmid:39159476
- View Article
- PubMed/NCBI
- Google Scholar
198. Miracolo A, Sophiea M, Mills M, Kanavos P. Sin taxes and their effect on consumption, revenue generation and health improvement: a systematic literature review in Latin America. Health Policy Plan. 2021;36(5):790–810. pmid:33885782
- View Article
- PubMed/NCBI
- Google Scholar
199. Hoe C, Weiger C, Cohen JE. Understanding why collective action resulted in greater advances for tobacco control as compared to alcohol control during the Philippines’ Sin Tax Reform: a qualitative study. BMJ Open. 2022;12(5):e054060. pmid:35636785
- View Article
- PubMed/NCBI
- Google Scholar
200. Capuno J, Ruiz Rivadeneria A, Beazley I, Maeda A, James C. Health financing and budgeting practices for health in the philippines. OECD J Budget. 2018;18(2).
- View Article
- Google Scholar
201. Javadinasab H, Masoudi Asl I, Vosoogh-Moghaddam A, Najafi B. Comparing selected countries using sin tax policy in sustainable health financing: Implications for developing countries. Int J Health Plann Manage. 2020;35(1):68–78. pmid:31273831
- View Article
- PubMed/NCBI
- Google Scholar
202. Jurberg C. Flawed but fair: Brazil’s health system reaches out to the poor. Bull World Health Organ. 2008;86(4):248–9. pmid:18438510
- View Article
- PubMed/NCBI
- Google Scholar
203. Oliveira R, Santinha G, Sá Marques T. The Impacts of Health Decentralization on Equity, Efficiency, and Effectiveness: A Scoping Review. Sustainability. 2023;16(1):386.
- View Article
- Google Scholar
204. Forman RP, Cylus J. Financing for health system transformation: spending more or spending better (or both)?. Copenhagen: WHO Regional Office for Europe. 2023.

[ref1] 1. Ministry of Health and Population. Basic Health Service Package In. Kathmandu: Ministry of Health and Population; 2019.

[ref2] 2. Khatri RB, Assefa Y, Durham J. Assessment of health system readiness for routine maternal and newborn health services in Nepal: Analysis of a nationally representative health facility survey, 2015. PLOS Glob Public Health. 2022;2(11):e0001298. pmid:36962692
View Article
PubMed/NCBI
Google Scholar

[3] View Article

[4] PubMed/NCBI

[5] Google Scholar

[ref3] 3. MOHP WB, WHO, GIZ. Situation Analysis of Health Financing in Nepal. Kathmandu: Government of Nepal, Ministry of Health and Population; 2019.

[ref4] 4. Khanal GN, Khatri RB. Burden, prevention and control of tobacco consumption in Nepal: a narrative review of existing evidence. Int Health. 2021;13(2):110–21. pmid:32914846
View Article
PubMed/NCBI
Google Scholar

[8] View Article

[9] PubMed/NCBI

[10] Google Scholar

[ref5] 5. LBD Double Burden of Malnutrition Collaborators. Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017. Nat Med. 2020;26(5):750–9. pmid:32313249
View Article
PubMed/NCBI
Google Scholar

[12] View Article

[13] PubMed/NCBI

[14] Google Scholar

[ref6] 6. National Statistical Office. National Population and Housing Census 2021. Kathmandu: Government of Nepal, Office of the Prime Minister and Council of Ministers; 2023.

[ref7] 7. Nepal Health Research Council; Ministry of Health and Population, Institute for Health Metrics and Evaluation, Monitoring Evaluation and Operational Research: Nepal Burden of Disease 2019. A Country Report based on the 2019 Global Burden of Disease Study In. Kathmandu: NHRC, MoHP, IHME, and MEOR; 2021.

[ref8] 8. National Statistics Office. Nepal Living Standard Survey IV 2022/23. Kathmandu: National Statistics Office, Office of the Prime Minister and Council of Ministers Government of Nepal; 2024.

[ref9] 9. Gardner H, Miles G, Saleem A, Dunin-Borkowska A, Mohammad H, Puttick N, et al. Social determinants of health and the double burden of disease in Nepal: a secondary analysis. BMC Public Health. 2022;22(1):1567. pmid:35978424
View Article
PubMed/NCBI
Google Scholar

[19] View Article

[20] PubMed/NCBI

[21] Google Scholar

[ref10] 10. Adhikari B, Mishra SR, Schwarz R. Transforming Nepal’s primary health care delivery system in global health era: addressing historical and current implementation challenges. Global Health. 2022;18(1):8. pmid:35101073
View Article
PubMed/NCBI
Google Scholar

[23] View Article

[24] PubMed/NCBI

[25] Google Scholar

[ref11] 11. World Health Organization. The Global Health Observatory: Explore a world of health data. Geneva: WHO; 2025.

[ref12] 12. World health Organization. Health systems financing: the path to universal coverage. In. Geneva: world health Organization; 2010: 1-–128.

[ref13] 13. World Health Organization. Global Health Expenditure Database. In. Geneva: WHO; 2025.

[ref14] 14. 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 Res Policy Syst. 2023;21(1):7. pmid:36670433
View Article
PubMed/NCBI
Google Scholar

[30] View Article

[31] PubMed/NCBI

[32] Google Scholar

[ref15] 15. Kuikel BS, Shrestha A, Xu DR, Shahi BB, Bhandari B, Mishra RK, et al. A critical analysis of health system in Nepal; Perspective’s based on COVID-19 response. Dialogues Health. 2023;3:100142. pmid:37325802
View Article
PubMed/NCBI
Google Scholar

[34] View Article

[35] PubMed/NCBI

[36] Google Scholar

[ref16] 16. Bhandari D, Bi P, Sherchand JB, Dhimal M, Hanson-Easey S. Climate change and infectious disease research in Nepal: Are the available prerequisites supportive enough to researchers?. Acta Trop. 2020;204:105337. pmid:31930962
View Article
PubMed/NCBI
Google Scholar

[38] View Article

[39] PubMed/NCBI

[40] Google Scholar

[ref17] 17. Shrestha N, Mishra SR, Ghimire S, Gyawali B, Marahatta SB, Maskey S, et al. Health System Preparedness for COVID-19 and Its Impacts on Frontline Health-Care Workers in Nepal: A Qualitative Study Among Frontline Health-Care Workers and Policy-Makers. Disaster Med Public Health Prep. 2021;:1–9. pmid:34140051
View Article
PubMed/NCBI
Google Scholar

[42] View Article

[43] PubMed/NCBI

[44] Google Scholar

[ref18] 18. WHO South-East Asia Region. Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the WHO South-East Asia Region: 2022 update. In. South-East Asia Region: World Health Organization; 2022.

[ref19] 19. His majesty’s government. Constitution of the kingdom of Nepal 1990. Ministry of Law Justice and Parliamentary Affairs. 1990.

[ref20] 20. Ministry of Health and Population. National Health Policy‐1991. In. Kathmandu: Ministry of Health and Population; 1991.

[ref21] 21. Government of Nepal. The Interim Constitution of Nepal 2007. In. Kathmandu: Government of Nepal; 2007.

[ref22] 22. Secretariat of CA. Constitution of Nepal 2015. Kathmandu Constituent Assembly Secretariat. 2015.

[ref23] 23. Government of Nepal. Health Insurance Act. In. Kathmandu, Nepal Government of Nepal; 2017.

[ref24] 24. Ministry of Health and Population. Annual Health Report 2021/2022. In. Kathmandu: Ministry of Health and Population; 2022.

[ref25] 25. Ministry of Health and Population. Nepal Health Sector Strategic Plan, 2022-2030. In. Kathmandu Ministry of Health and Population; 2022.

[ref26] 26. Ministry of Health and Population. National Health Financing Strategy, 2023-2033. In. Kathmandu: Ministry of Health and Population; 2023.

[ref27] 27. Acharya D, Devkota B, Kreps GL. Does perceived susceptibility and severity of health problems serve as drivers for household enrolment in health insurance? A case study from Nepal. Int J Health Plann Manage. 2022;37(2):839–53. pmid:34719054
View Article
PubMed/NCBI
Google Scholar

[55] View Article

[56] PubMed/NCBI

[57] Google Scholar

[ref28] 28. Acharya D, Sharma S, Bietsch K. Enrollment and associated factors of the national health insurance program of Nepal: Further analysis of the Nepal Demographic and Health Survey 2022. PLoS One. 2024;19(10):e0310324. pmid:39361628
View Article
PubMed/NCBI
Google Scholar

[59] View Article

[60] PubMed/NCBI

[61] Google Scholar

[ref29] 29. Pandey AR. Health financing reforms in the quest for universal health coverage: Challenges and opportunities in the context of Nepal. J Glob Health. 2023;13:03021. pmid:37114984
View Article
PubMed/NCBI
Google Scholar

[63] View Article

[64] PubMed/NCBI

[65] Google Scholar

[ref30] 30. Ayer R, Tiwari S, Jnawali SP, Dael R. A Study on Nepal’s National Health Insurance Program. In. Manila: Asian Development Bank; 2024.

[ref31] 31. International Labour Organization. Social health protection in Nepal. State of play and recommendations towards universal extension of coverage. In. Kathmandu: International Labour Organization; 2023.

[ref32] 32. International Labour Organization. Extending social protection for all in Nepal, an analysis of protection gaps. In. Kathmandu: International Labour Organization; 2023.

[ref33] 33. Ghimire S, Ghimire S, Singh DR, Sagtani RA, Paudel S. Factors influencing the utilisation of National health insurance program in urban areas of Nepal: Insights from qualitative study. PLOS Glob Public Health. 2024;4(7):e0003538. pmid:39058732
View Article
PubMed/NCBI
Google Scholar

[70] View Article

[71] PubMed/NCBI

[72] Google Scholar

[ref34] 34. 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 Serv Res. 2023;23(1):159. pmid:36793046
View Article
PubMed/NCBI
Google Scholar

[74] View Article

[75] PubMed/NCBI

[76] Google Scholar

[ref35] 35. Shrestha R, Shakya A, Khanal P, Khanal VK, Jha N, Nepal Gurung G, et al. User satisfaction with the National Health Insurance Program: A community-based survey from the Ilam district of Nepal. PLoS One. 2024;19(5):e0303045. pmid:38787905
View Article
PubMed/NCBI
Google Scholar

[78] View Article

[79] PubMed/NCBI

[80] Google Scholar

[ref36] 36. Pokharel S, Acharya SR, Pahari S, Moon DH, Shin YC. Utilization of Healthcare Services & Healthcare Expenditure Patterns in the Rural Households of Nepal. APJHM. 2021;16(1):86–94.
View Article
Google Scholar

[82] View Article

[83] Google Scholar

[ref37] 37. Acharya D, Thapa KB, Sharma B, Rana MS. Causes of dropout from health insurance program: An experience from Lumbini Province, Nepal. Dialogues Health. 2023;3:100150. pmid:38515800
View Article
PubMed/NCBI
Google Scholar

[85] View Article

[86] PubMed/NCBI

[87] Google Scholar

[ref38] 38. Peters MDJ, Marnie C, Colquhoun H, Garritty CM, Hempel S, Horsley T, et al. Scoping reviews: reinforcing and advancing the methodology and application. Syst Rev. 2021;10(1):263. pmid:34625095
View Article
PubMed/NCBI
Google Scholar

[89] View Article

[90] PubMed/NCBI

[91] Google Scholar

[ref39] 39. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005;8(1):19–32.
View Article
Google Scholar

[93] View Article

[94] Google Scholar

[ref40] 40. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. pmid:20854677
View Article
PubMed/NCBI
Google Scholar

[96] View Article

[97] PubMed/NCBI

[98] Google Scholar

[ref41] 41. World Health Organization. Making fair choices on the path to universal health coverage: Final report of the WHO Consultative Group on Equity and Universal Health Coverage. In. Geneva: World Health Organization; 2014.

[ref42] 42. World Health Organization. Universal health coverage and health financing. In. vol. 18. Geneva: World Health Organization; 2019.

[ref43] 43. MOHP and NHSSP. Review of national health policy 1991. In. Kathmandu: MOHP and NHSSP; 2012.

[ref44] 44. Nepal Go. Social Health Security Development Board Development Board (formation) Order 2014 In. Kathmandu: Government of Nepal; 2014.

[ref45] 45. Ministry of Health and Population. Progress of health and population sector 2023/24. In. Kathmandu: Ministry of Health and Population; 2024.

[ref46] 46. Health Insurance Board. Acts, rules, directives and procedures. In. Kathmandu: Health Insurance Board; 2024.

[ref47] 47. Gurung GB, Panza A. Predictors of annual membership renewal to increase the sustainability of the Nepal National Health Insurance program: A cross-sectional survey. PLOS Glob Public Health. 2022;2(4):e0000201. pmid:36962197
View Article
PubMed/NCBI
Google Scholar

[106] View Article

[107] PubMed/NCBI

[108] Google Scholar

[ref48] 48. Health Insurance Borard. Operational guideline for implementation of co-payment system in the health insurance program, 2080 In. Kathmandu: Health Insurance Board; 2024.

[ref49] 49. Ministry of Health and Population. Annual Health Report 2022/2023. In. Kathmandu: Ministry of Health and Population; 2024.

[ref50] 50. Health Insurance Borard. Accreditation guideline for service providing facilities, 2024. In. Kathmandu: Health Insurance Board; 2024.

[ref51] 51. Health Insurance Board. Annual report 2022/23: factsheet and executive summary. In. Kathmandu: Health Insurance Board; 2024.

[ref52] 52. Government of Nepal. Public Health Service Act. In. Kathmandu, Nepal: Government of Nepal; 2018.

[ref53] 53. Ministry of Health and Population. Standard Treatment Protocol (STP) For Basic Health Services (BHS) Package 2078. In. Kathmandu: Ministry of Health and Population; 2020.

[ref54] 54. Ministry of Health and Population. Standard Treatment Protocol of Emergency Health Service Package. In. Kathmandu: Ministry of Health and Population; 2020.

[ref55] 55. Poudel P, Khatri R, Bhatt L, Thapa P, Mishra RK, Tuladhar S, Panahi E: Baseline Status of Basic Health Service Delivery, 2022 Nepal DHS and 2021 Nepal HFS. DHS Further Analysis Reports No. 157. In. Kathmandu Rockville, Maryland, USA: ICF; and Kathmandu, Nepal: MoHP; 2024.

[ref56] 56. Government of Nepal. Health Insurance Regulation. In. Kathmandu, Nepal: Government of Nepal; 2019.

[ref57] 57. Ministry of Health and Population. National Health Policy 1991. In. Kathmandu: Ministry of Health and Population; 1991.

[ref58] 58. Stoermer M, Fuerst F, Rijal K, Bhandari R, Nogier C, Gautam GS, et al. Review of community-based health insurance initiatives in Nepal. Kathmandu: Deutsche Gesellschaft für internationale Zusammenarbeit (GIZ) Gmb; 2012.

[ref59] 59. Pandey S, Daley A. Free delivery care and supply-side incentives in Nepal’s poorest districts: the effect on prenatal care and neonatal tetanus vaccinations. Journal of Development Effectiveness. 2020;13(1):100–15.
View Article
Google Scholar

[121] View Article

[122] Google Scholar

[ref60] 60. Witter S, Khadka S, Nath H, Tiwari S. The national free delivery policy in Nepal: early evidence of its effects on health facilities. Health Policy Plan. 2011;26 Suppl 2:ii84-91. pmid:22027923
View Article
PubMed/NCBI
Google Scholar

[124] View Article

[125] PubMed/NCBI

[126] Google Scholar

[ref61] 61. Ministry of Health and Population. National Health Policy 2014. In. Kathmandu: Ministry of Health and Population; 2014.

[ref62] 62. MoH and NHSSP. Budget Analysis of Ministry of Health FY 2017/18. In. Kathmandu: Ministry of Health and Nepal Health Sector Support Programme; 2018.

[ref63] 63. Uprety S, Lamichhane B. Health budgeting and financing in nepal: policy perspectives. Health Policy. 2016.
View Article
Google Scholar

[130] View Article

[131] Google Scholar

[ref64] 64. Ministry of Health and Population. National Health Policy 2019. In. Kathmandu: Ministry of Health and Population; 2019.

[ref65] 65. Ministry of Health and Population. Directives, Guidelines and Manuals. In. Kathmandu: Ministry of Health and Population 2021.

[ref66] 66. NHRC. Towards Universal Health Coverage: Addressing Financial Hardship and Improving Access to Healthcare in Nepal (Policy brief). Kathmandu: Nepal Health Research Council; 2022.

[ref67] 67. Wasti SP, van Teijlingen E, Rushton S, Subedi M, Simkhada P, Balen J, et al. Overcoming the challenges facing Nepal’s health system during federalisation: an analysis of health system building blocks. Health Res Policy Syst. 2023;21(1):117. pmid:37919769
View Article
PubMed/NCBI
Google Scholar

[136] View Article

[137] PubMed/NCBI

[138] Google Scholar

[ref68] 68. Ministry of Health and Population. National Health Insurance Policy 2014. In. Kathmandu: Ministry of Health and Population; 2014.

[ref69] 69. Ministry of Health and Population. Nepal Health Sector Strategy, 2010-2015. In. Kathmandu: Nepal Government of Nepal; 2010.

[ref70] 70. Ministry of Health and Population. Nepal Health Sector Strategy, 2015-2022. In. Kathmandu: Nepal Government of Nepal; 2015.

[ref71] 71. Government of Nepal. Budget Details: Red Book (Fiscal year 2010/11) In. Kathmandu: Ministry of Finance; 2014.

[ref72] 72. Ministry of Health and Population. Strategic Review of Social Audit in the Health Sector. Kathmandu: Ministry of Health and Population; 2019.

[ref73] 73. Ministry of Health and Population. Progress Report on Financial Management In Nepal’s Health Sector. Kathmandu: Ministry of Health and Population; 2014.

[ref74] 74. Daniels D, Ghimire K, Thapa P, Réveillon M, Pathak DR, Baral K, et al. Nepal health sector programme II mid-term review. Kathmandu: Ministry of Health. 2013.

[ref75] 75. NHSSP. Innovative Good Practices in Nepal’s Health Sector. In. Kathmandu: NHSSP; 2016.

[ref76] 76. Ministry of Health and Population. Annual Health Report 2016/17. In. Kathmandu: Ministry of Health and Population; 2018.

[ref77] 77. Ministry of Health and Population. Nepal National Health Accounts 2015/16 report In. Kathmandu: Ministry of Health and Population; 2018.

[ref78] 78. Employee Provident Fund. Annual Report of Employee Provident Fund. Lalitpur: Employee Provident Fund, Government of Nepal; 2020.

[ref79] 79. 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 Res Policy Syst. 2023;21(1):7. pmid:36670433
View Article
PubMed/NCBI
Google Scholar

[151] View Article

[152] PubMed/NCBI

[153] Google Scholar

[ref80] 80. Ministry of Health and Population. Partnership, Alignment and Harmonisation in the Health Sector. Kathmandu: Ministry of Health and Population; 2015.

[ref81] 81. Ministry of Health and Population. Nepal Health Sector Strategy (NHSS) Mid Term Review Report. Kathmandu: Ministry of Health and Population; 2018.

[ref82] 82. Khanal P, Mishra SR. Federal governance and the undying parade for universal health coverage in Nepal. Health Prospect. 2019;18(1):1–3.
View Article
Google Scholar

[157] View Article

[158] Google Scholar

[ref83] 83. Aryal KK. Free Basic Healthcare in Nepal: Can the Dream be Turned into Reality in the Pursuit of Universal Health Coverage?. J Nepal Health Res Counc. 2023;21(1):i–iii. pmid:37742139
View Article
PubMed/NCBI
Google Scholar

[160] View Article

[161] PubMed/NCBI

[162] Google Scholar

[ref84] 84. Nepal Health Research Council. Towards Universal Health Coverage: Addressing Financial Hardship and Improv ing Access to Healthcare in Nepal (Policy brief). Kathmandu: Nepal Health Research Council; 2022.

[ref85] 85. Ministry of Health and Population. Nepal Health Sector Support Programme 2017-2022 Achievements, Learning and Future Approaches: Results Brief. Kathmandu: Ministry of Health and Population; 2022.

[ref86] 86. Ministry of Health and Population, NHSSP, Options. Nepal Health Sector Support Programme (NHSSP 3) – No Cost Extension. Kathmandu: Ministry of Health and Population; 2023.

[ref87] 87. Health Insurance Reform Proposal Task Force. Health Insurance Reform Proposal Task Force Report, 2081 (2025), Nepali version In. Kathmandu: Ministry of Health and Population; 2025.

[ref88] 88. Ministry of Health and Population. Medical treatment of deprived citizens. vol. 2025. Kathmandu: Ministry of Health and Population; 2025.

[ref89] 89. Social Security Fund. Annual Report 2023/2024. Kathmandu: Social Security Fund; 2024.

[ref90] 90. Employee Provident Fund. Annual Report of Employee Provident Fund 2022/2023. Lalitpur: Employee Provident Fund, Government of Nepal; 2024.

[ref91] 91. Employees Providednt Fund. Healthcare Plan. vol. 2024. Kathmandu: Employees Providednt Fund; 2024.

[ref92] 92. Ministry of Health and Population. Social Service Unit Establishment and Operational Guidelines. Kathmandu: Ministry of Health and Population; 2020.

[ref93] 93. Ministry of Health and Population. Senior Citizen Health Service Operation Guideline 2077 (2021). In. Kathmandu: Ministry of Health and Population; 2021.

[ref94] 94. Ministry of Health and Population. Nepal Health Sector Strategy, 2004-2009. In. Kathmandu: Nepal Government of Nepal; 2005.

[ref95] 95. Ministry of Health and Population, New ERA, ICF. 2022 Nepal Demographic and Health Survey Key Findings. Kathmandu: Ministry of Health and Population; 2023.

[ref96] 96. National Centre for AIDS and STD Control. National HIV Factsheet. Kathmandu: Ministry of Health and Population; 2023.

[ref97] 97. Government of Nepal. Public Health Service Regulation 2020 (unofficial translation). Kathmandu: Ministry of Health and Population; 2020.

[ref98] 98. Central Bureau of Statistics (CBS). Nepal Multiple Indicator Cluster Survey 2019,Survey Findings Report. Kathmandu: Central Bureau of Statistics and UNICEF Nepal; 2020.

[ref99] 99. Social Security Fund. Daily Summary Report as of 09 Jan 2024. Kathmandu: Social Security Fund; 2024.

[ref100] 100. Social Security Fund. Daily summary report as of 7 October 2023. Kathmandu: Social Security Fund, Government of Nepal; 2023.

[ref101] 101. Ministry of Health and Population. Geriatrics (Senior Citizens) Health Service Operational Guideline- 2023/24. Kathmandu: Ministry of Health and Population; 2024.

[ref102] 102. Gartoulla P, Liabsuetrakul T, Chongsuvivatwong V, McNeil E. Ability to pay and impoverishment among women who give birth at a University Hospital in Kathmandu, Nepal. Glob Public Health. 2012;7(10):1145–56. pmid:23083138
View Article
PubMed/NCBI
Google Scholar

[182] View Article

[183] PubMed/NCBI

[184] Google Scholar

[ref103] 103. Ensor T, Bhatt H, Tiwari S. Incentivizing universal safe delivery in Nepal: 10 years of experience. Health Policy Plan. 2017;32(8):1185–92. pmid:28591799
View Article
PubMed/NCBI
Google Scholar

[186] View Article

[187] PubMed/NCBI

[188] Google Scholar

[ref104] 104. Rana K, Chimoriya R, Haque NB, Piya MK, Chimoriya R, Ekholuenetale M, et al. Prevalence and Correlates of Underweight among Women of Reproductive Age in Nepal: A Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(18):11737. pmid:36142012
View Article
PubMed/NCBI
Google Scholar

[190] View Article

[191] PubMed/NCBI

[192] Google Scholar

[ref105] 105. World Health Organization. Tracking universal health coverage: 2023 global monitoring report. In. Geneva: World Health Organization; 2023.

[ref106] 106. World Health Organization. Tracking Universal Health Coverage: global monitoring report. In. Geneva: World Health Organization and International Bank for Reconstruction and Development/The World Bank; 2021.

[ref107] 107. Atreya A, Shrestha DB, Budhathoki P, Nepal S. Epidemiology of Road Traffic Accidents in Nepal from 2009/10 to 2019/20: A 10 Year Study. J Nepal Health Res Counc. 2021;19(2):343–8. pmid:34601528
View Article
PubMed/NCBI
Google Scholar

[196] View Article

[197] PubMed/NCBI

[198] Google Scholar

[ref108] 108. Sapkota BP, Baral KP, Berger U, Parhofer KG, Rehfuess EA. Health sector readiness for the prevention and control of non-communicable diseases: A multi-method qualitative assessment in Nepal. PLoS One. 2022;17(9):e0272361. pmid:36178897
View Article
PubMed/NCBI
Google Scholar

[200] View Article

[201] PubMed/NCBI

[202] Google Scholar

[ref109] 109. Adhikari B, Pandey A, Lamichhane B, KC S, Joshi D, Regmi S, et al. Non-communicable disease service readiness in Nepal: a further analysis of Nepal health facility survey-2021. medRxiv. 2023;2023:2023.2002.2007.23285512.
View Article
Google Scholar

[204] View Article

[205] Google Scholar

[ref110] 110. Adhikari TB, Acharya P, Högman M, Neupane D, Karki A, Drews A, et al. Prevalence of Chronic Obstructive Pulmonary Disease and its Associated Factors in Nepal: Findings from a Community-based Household Survey. Int J Chron Obstruct Pulmon Dis. 2020;15:2319–31. pmid:33061350
View Article
PubMed/NCBI
Google Scholar

[207] View Article

[208] PubMed/NCBI

[209] Google Scholar

[ref111] 111. Acharya KP, Wilson RT. Antimicrobial Resistance in Nepal. Front Med (Lausanne). 2019;6:105. pmid:31179281
View Article
PubMed/NCBI
Google Scholar

[211] View Article

[212] PubMed/NCBI

[213] Google Scholar

[ref112] 112. Ministry of Health and Population. A review of studies on Nepal’s national free health care programme. Kathmandu: Primary Health Care Revitalization Division, Department of Health Services; 2013.

[ref113] 113. Khanal GN. Conditional cash transfer policies in maternal health service utilization in Nepal: Analysis of safe delivery incentive program (Aama Surakshya Karyakram) using Kingdon’s multiple streams framework. Int J Health Plann Manage. 2019;34(1):e131–41. pmid:30370556
View Article
PubMed/NCBI
Google Scholar

[216] View Article

[217] PubMed/NCBI

[218] Google Scholar

[ref114] 114. Acharya S, Ghimire S, Jeffers EM, Shrestha N. Health Care Utilization and Health Care Expenditure of Nepali Older Adults. Front Public Health. 2019;7:24. pmid:30828573
View Article
PubMed/NCBI
Google Scholar

[220] View Article

[221] PubMed/NCBI

[222] Google Scholar

[ref115] 115. Karmacharya I, Ghimire S, Bhujel K, Shrestha Dhauvadel A, Adhikari S, Baral S, et al. Health Services Utilization among Older Adults in Pokhara Metropolitan City. J Aging Soc Policy. 2022;34(4):568–87. pmid:33433265
View Article
PubMed/NCBI
Google Scholar

[224] View Article

[225] PubMed/NCBI

[226] Google Scholar

[ref116] 116. Ranabhat CL, Subedi R, Karn S. Status and determinants of enrollment and dropout of health insurance in Nepal: an explorative study. Cost Eff Resour Alloc. 2020;18:40. pmid:33013204
View Article
PubMed/NCBI
Google Scholar

[228] View Article

[229] PubMed/NCBI

[230] Google Scholar

[ref117] 117. Ranabhat CL, Kim C-B, Singh DR, Park MB. A Comparative Study on Outcome of Government and Co-Operative Community-Based Health Insurance in Nepal. Front Public Health. 2017;5:250. pmid:29062833
View Article
PubMed/NCBI
Google Scholar

[232] View Article

[233] PubMed/NCBI

[234] Google Scholar

[ref118] 118. Pokharel R, Silwal P. Social health insurance in nepal: A health system departure toward the universal health coverage. Int J Health Plann Manage. 2018.
View Article
Google Scholar

[236] View Article

[237] Google Scholar

[ref119] 119. Kandel N. Nepal Health Insurance Bill: Possible Challenges and Way Forwards. JNMA J Nepal Med Assoc. 2018;56(210):633–9. pmid:30376011
View Article
PubMed/NCBI
Google Scholar

[239] View Article

[240] PubMed/NCBI

[241] Google Scholar

[ref120] 120. Sharma P, Yadav DK, Shrestha N, Ghimire P. Dropout Analysis of a National Social Health Insurance Program at Pokhara Metropolitan City, Kaski, Nepal. Int J Health Policy Manag. 2022;11(11):2476–88. pmid:35042322
View Article
PubMed/NCBI
Google Scholar

[243] View Article

[244] PubMed/NCBI

[245] Google Scholar

[ref121] 121. Adhikari R, Shah R, Khanal V. Older people’s challenges accessing health services in central Nepal: a qualitative study using the domain of access framework. BMC Health Serv Res. 2024;24(1):1273. pmid:39443984
View Article
PubMed/NCBI
Google Scholar

[247] View Article

[248] PubMed/NCBI

[249] Google Scholar

[ref122] 122. Ministry of Health and Population. Annual report 2022/23: factsheet and executive summary. Kathmandu: Ministry of Health and Population; 2024.

[ref123] 123. Ministry of Health and Population. Annual Health Report 2020/21. Kathmandu: Ministry of Health and Population; 2020.

[ref124] 124. Paudel A: Work on 400 basic hospitals in local units may not start next fiscal year. In: The Kathmandu Post. Kathmandu: Kantipur Media Pvt Ltd; 2023.

[ref125] 125. Ministry of Health and Population. National joint annual review report. Ramshahpath, Kathmandu Nepal: Ministry of Health and Population; 2024.

[ref126] 126. Ghimire P, Sapkota VP, Poudyal AK. Factors Associated with Enrolment of Households in Nepal’s National Health Insurance Program. Int J Health Policy Manag. 2019;8(11):636–45. pmid:31779289
View Article
PubMed/NCBI
Google Scholar

[255] View Article

[256] PubMed/NCBI

[257] Google Scholar

[ref127] 127. Bhusal UP, Sapkota VP. Predictors of health insurance enrolment and wealth-related inequality in Nepal: evidence from Multiple Indicator Cluster Survey (MICS) 2019. BMJ Open. 2021;11(11):e050922. pmid:34836898
View Article
PubMed/NCBI
Google Scholar

[259] View Article

[260] PubMed/NCBI

[261] Google Scholar

[ref128] 128. Paudel DR. Factors Affecting Enrollment in Government Health Insurance Program in Kailali District. J Nepal Health Res Counc. 2019;17(3):388–93. pmid:31735937
View Article
PubMed/NCBI
Google Scholar

[263] View Article

[264] PubMed/NCBI

[265] Google Scholar

[ref129] 129. Adhikari N, Wagle RR, Adhikari DR, Thapa P, Adhikari M. Factors Affecting Enrolment in the Community Based Health Insurance Scheme of Chandranigahapur Hospital of Rautahat District. J Nepal Health Res Counc. 2019;16(41):378–84. pmid:30739922
View Article
PubMed/NCBI
Google Scholar

[267] View Article

[268] PubMed/NCBI

[269] Google Scholar

[ref130] 130. Gurung GB, Panza A. Implementation bottlenecks of the National Health Insurance program in Nepal: Paving the path towards Universal Health Coverage: A qualitative study. Int J Health Plann Manage. 2022;37(1):171–88. pmid:34505317
View Article
PubMed/NCBI
Google Scholar

[271] View Article

[272] PubMed/NCBI

[273] Google Scholar

[ref131] 131. Mishra SR, Khanal P, Karki DK, Kallestrup P, Enemark U. National health insurance policy in Nepal: challenges for implementation. Glob Health Action. 2015;8:28763. pmid:26300556
View Article
PubMed/NCBI
Google Scholar

[275] View Article

[276] PubMed/NCBI

[277] Google Scholar

[ref132] 132. Our World in Data. Country profile:Nepal. In. Oxford: Oxford Martin School, University of Oxford; 2023.

[ref133] 133. IQAir. Air quality in Nepal Air quality in Nepal In.; 2022.

[ref134] 134. Ministry of Health and Population. Nepal National Health Accounts 2018/19 – 2019/20. Kathmandu: Ministry of Health and Population; 2023.

[ref135] 135. Sapkota VP, Bhusal UP, Adhikari GP. Occupational and geographical differentials in financial protection against healthcare out-of-pocket payments in Nepal: Evidence for universal health coverage. PLoS One. 2023;18(1):e0280840. pmid:36706091
View Article
PubMed/NCBI
Google Scholar

[282] View Article

[283] PubMed/NCBI

[284] Google Scholar

[ref136] 136. Swe KT, Rahman MM, Rahman MS, Saito E, Abe SK, Gilmour S, et al. Cost and economic burden of illness over 15 years in Nepal: A comparative analysis. PLoS One. 2018;13(4):e0194564. pmid:29617393
View Article
PubMed/NCBI
Google Scholar

[286] View Article

[287] PubMed/NCBI

[288] Google Scholar

[ref137] 137. Pyakurel P, Tripathy JP, Oo MM, Acharya B, Pyakurel U, Singh SB, et al. Catastrophic health expenditure among industrial workers in a large-scale industry in Nepal, 2017: a cross-sectional study. BMJ Open. 2018;8(11):e022002. pmid:30446573
View Article
PubMed/NCBI
Google Scholar

[290] View Article

[291] PubMed/NCBI

[292] Google Scholar

[ref138] 138. Saito E, Gilmour S, Rahman MM, Gautam GS, Shrestha PK, Shibuya K. Catastrophic household expenditure on health in Nepal: a cross-sectional survey. Bull World Health Organ. 2014;92(10):760–7. pmid:25378730
View Article
PubMed/NCBI
Google Scholar

[294] View Article

[295] PubMed/NCBI

[296] Google Scholar

[ref139] 139. Rai S, Gautam S, Yadav GK, Niraula SR, Singh SB, Rai R, et al. Catastrophic health expenditure on chronic non-communicable diseases among elder population: A cross-sectional study from a sub-metropolitan city of Eastern Nepal. PLoS One. 2022;17(12):e0279212. pmid:36512634
View Article
PubMed/NCBI
Google Scholar

[298] View Article

[299] PubMed/NCBI

[300] Google Scholar

[ref140] 140. Thapa AK, Pandey AR. National and Provincial Estimates of Catastrophic Health Expenditure and its Determinants in Nepal. J Nepal Health Res Counc. 2021;18(4):741–6. pmid:33510521
View Article
PubMed/NCBI
Google Scholar

[302] View Article

[303] PubMed/NCBI

[304] Google Scholar

[ref141] 141. Ghimire M, Ayer R, Kondo M. Cumulative incidence, distribution, and determinants of catastrophic health expenditure in Nepal: results from the living standards survey. Int J Equity Health. 2018;17(1):23. pmid:29444686
View Article
PubMed/NCBI
Google Scholar

[306] View Article

[307] PubMed/NCBI

[308] Google Scholar

[ref142] 142. Khatiwoda SR, Dhungana RR, Sapkota VP, Singh S. Estimating the Direct Cost of Cancer in Nepal: A Cross-Sectional Study in a Tertiary Cancer Hospital. Front Public Health. 2019;7:160. pmid:31294011
View Article
PubMed/NCBI
Google Scholar

[310] View Article

[311] PubMed/NCBI

[312] Google Scholar

[ref143] 143. Shrestha A, Parajuli SB, Aryal A, Shrestha A, Maharjan R, Jha N, et al. National Needs Assessment of Health Information System to Address Cardiovascular Diseases in Nepal: A Mixed Method Study. Kathmandu Univ Med J (KUMJ). 2021;19(75):58–67. pmid:35526137
View Article
PubMed/NCBI
Google Scholar

[314] View Article

[315] PubMed/NCBI

[316] Google Scholar

[ref144] 144. Dulal RK, Magar A, Karki SD, Khatiwada D, Hamal PK. Analysis of Health Sector Budget of Nepal. JNMA J Nepal Med Assoc. 2014;52(194):811–21. pmid:26905710
View Article
PubMed/NCBI
Google Scholar

[318] View Article

[319] PubMed/NCBI

[320] Google Scholar

[ref145] 145. Gupta I, Chowdhury S. Correlates of out-of-pocket spending on health in Nepal: implications for policy. WHO South East Asia J Public Health. 2014;3(3):238–46. pmid:28612808
View Article
PubMed/NCBI
Google Scholar

[322] View Article

[323] PubMed/NCBI

[324] Google Scholar

[ref146] 146. Evidence on social health protection for strong institutions. In: 9th National Virtual Summit of Health and Population Scientists in Nepal. Kathmandu, Nepal: Nepal Health Research Council. 2023.

[ref147] 147. MoHP and UKaid/NHSSP. Budget Analysis of Health Sector In. Kathmandu: Ministry of Health and Population and UKaid/Nepal Health Sector Support Programme; 2020.

[ref148] 148. Institute for Health Metrics and Evaluation. Nepal, All-cause, Spending as % of GDP, 1995-2024. Seatle: Institute for Health Metrics and Evaluation; 2023.

[ref149] 149. United Nations International Children’s Emergency Fund. Budget Brief Updates. Health Budget: FY 2021/22 In. Kathmandu: United Nations International Children’s Emergency Fund; 2021.

[ref150] 150. Ministry of Health and Population. Nepal National Health Accounts 2017/18 report In. Kathmandu: Ministry of Health and Population; 2022.

[ref151] 151. Ministry of Health and Population. Nepal National Health Accounts 2016/17. Kathmandu: Ministry of Health and Population; 2019.

[ref152] 152. Ministry of Health and Population. Nepal National Health Accounts 2017/18. Kathmandu: Ministry of Health and Population; 2022.

[ref153] 153. Pandey A, Baral P, Shrestha A. Non-communicable diseases and their risk factors: panel discussion on its interventions in Nepal. Webinar and panel discussion organised by Nepal Public Health Association. Kathmandu, Nepal: Nepal Public Health Association. 2023.

[ref154] 154. Ministry of Health and Population, NHSSP. Health Sector Budget Analysis: First Five Years of Federalism. In. Kathmandu: Ministry of Health and Population, BEK/Nepal Health Sector Support Programme; 2022.

[ref155] 155. Ministry of Health and Population, Nepal Health Sector Support Programme. Budget Analysis of Ministry of Health FY 2021/22. In. Kathmandu: Ministry of Health and Population, Nepal Health Sector Support Programme; 2022.

[ref156] 156. Gyanwali S. Status, challenges and way forward for Health Insurance Programme in Nepal (Inv Talk). In: 9th National Virtual Summit of Health and Population Scientists in Nepal. Kathmandu, Nepal; 2023.

[ref157] 157. Shrestha A, Maharjan R, Karmacharya BM, Bajracharya S, Jha N, Shrestha S, et al. Health system gaps in cardiovascular disease prevention and management in Nepal. BMC Health Serv Res. 2021;21(1):655. pmid:34225714
View Article
PubMed/NCBI
Google Scholar

[337] View Article

[338] PubMed/NCBI

[339] Google Scholar

[ref158] 158. Acharya D, Devkota B, Gautam K, Bhattarai R. Association of information, education, and communication with enrolment in health insurance: a case of Nepal. Arch Public Health. 2020;78(1):135. pmid:33317622
View Article
PubMed/NCBI
Google Scholar

[341] View Article

[342] PubMed/NCBI

[343] Google Scholar

[ref159] 159. Ranabhat CL, Kim C-B, Singh A, Acharya D, Pathak K, Sharma B, et al. Challenges and opportunities towards the road of universal health coverage (UHC) in Nepal: a systematic review. Arch Public Health. 2019;77:5. pmid:30740223
View Article
PubMed/NCBI
Google Scholar

[345] View Article

[346] PubMed/NCBI

[347] Google Scholar

[ref160] 160. Gyawali B, Khanal P, Mishra SR, van Teijlingen E, Wolf Meyrowitsch D. Building Strong Primary Health Care to Tackle the Growing Burden of Non-Communicable Diseases in Nepal. Glob Health Action. 2020;13(1):1788262. pmid:32696724
View Article
PubMed/NCBI
Google Scholar

[349] View Article

[350] PubMed/NCBI

[351] Google Scholar

[ref161] 161. Gartaula P, Neupane S, Thakur DN, Sangroula RK. Out of pocket Expenditure on Health Service Delivery at a Tertiary Care Women’s Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2020;58(232):1024–7. pmid:34506383
View Article
PubMed/NCBI
Google Scholar

[353] View Article

[354] PubMed/NCBI

[355] Google Scholar

[ref162] 162. Shah S, Jha N, Khanal VK, Nepal Gurung G, Sharma B, Shrestha M. Utilization of social health security scheme among the households of Illam district, Nepal. PLoS One. 2022;17(5):e0265993. pmid:35536839
View Article
PubMed/NCBI
Google Scholar

[357] View Article

[358] PubMed/NCBI

[359] Google Scholar

[ref163] 163. Ministry of Home Affairs. Standards Related toTreatment Expenses, Relief, and Financial Assistance, 2077 In. Kathmandu: Ministry of Home Affairs, Government of Nepal; 2019.

[ref164] 164. Basnet MB. Access to the poor’s money, who took how much (list) (Nepali). In: Himal Khabar Kathmandu; 2023.

[ref165] 165. Reporter Swasthya Khabar Pratika. Government’s decision to bear former Prime Minister Khanal’s medical expenses, violating the provisions of the Act. In: Swasthya Khabar Pratika. Kathmandu; 2021.

[ref166] 166. Ministry of Health and Population. Working procedure related to citizen relief, compensation and financial support. Kathmandu: Ministry of Health and Population; 2016.

[ref167] 167. World Bank. GDP (current US$) - Nepal. In. Online: The World Bank data; 2024.

[ref168] 168. Adhikari SR, Raut NK: Size of informal economy in Nepal. In. Kathmandu: Tribhuvan University, Nepal Rastra Bank; 2024.

[ref169] 169. Nepal Rastra Bank. Annual report FY 2022/23. In. Kathmandu: Nepal Rastra Bank,Economic Research Department Publication Division; 2023.

[ref170] 170. Bahl RW, Timofeev A, Yilmaz S. Implementing federalism: The case of Nepal. Public Budgeting & Finance. 2022;42(3):23–40.
View Article
Google Scholar

[368] View Article

[369] Google Scholar

[ref171] 171. Ministry of Finance Budget speech 2024/25. In. Kathmandu: Ministry of Finance; 2024.

[ref172] 172. Sapkota T, Houkes I, Bosma H. Vicious cycle of chronic disease and poverty: a qualitative study in present day Nepal. Int Health. 2021;13(1):30–8. pmid:32352145
View Article
PubMed/NCBI
Google Scholar

[372] View Article

[373] PubMed/NCBI

[374] Google Scholar

[ref173] 173. Flessa S. Sector-Wide Approach (SWAp) in Healthcare-A Mixed-Methods Assessment of Health SWAps in Nepal and Bangladesh. Int J Environ Res Public Health. 2024;21(12):1682. pmid:39767523
View Article
PubMed/NCBI
Google Scholar

[376] View Article

[377] PubMed/NCBI

[378] Google Scholar

[ref174] 174. Witter S, Bertone MP, Baral S, Gautam G, Pratap SKC, Pholpark A, et al. Political economy analysis of health financing reforms in times of crisis: findings from three case studies in south-east Asia. Int J Equity Health. 2025;24(1):34. pmid:39901272
View Article
PubMed/NCBI
Google Scholar

[380] View Article

[381] PubMed/NCBI

[382] Google Scholar

[ref175] 175. Ghimire DK. Corruption and underdevelopment in Nepal: a content analysis. Dhaulagiri J Sociol Anthropol. 2022;16.
View Article
Google Scholar

[384] View Article

[385] Google Scholar

[ref176] 176. Yazbeck AS, Soucat AL, Tandon A, Cashin C, Kutzin J, Watson J, et al. Addiction to a bad idea, especially in low- and middle-income countries: Contributory health insurance. Soc Sci Med. 2023;320:115168. pmid:36822716
View Article
PubMed/NCBI
Google Scholar

[387] View Article

[388] PubMed/NCBI

[389] Google Scholar

[ref177] 177. Gabani J, Mazumdar S, Suhrcke M. The effect of health financing systems on health system outcomes: A cross-country panel analysis. Health Econ. 2023;32(3):574–619. pmid:36480236
View Article
PubMed/NCBI
Google Scholar

[391] View Article

[392] PubMed/NCBI

[393] Google Scholar

[ref178] 178. Mathauer I, Vinyals Torres L, Kutzin J, Jakab M, Hanson K. Pooling financial resources for universal health coverage: options for reform. Bull World Health Organ. 2020;98(2):132–9. pmid:32015584
View Article
PubMed/NCBI
Google Scholar

[395] View Article

[396] PubMed/NCBI

[397] Google Scholar

[ref179] 179. Joarder T, Chaudhury TZ, Mannan I. Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions. Psyche (Camb Mass). 2019;2019:4954095. pmid:33281233
View Article
PubMed/NCBI
Google Scholar

[399] View Article

[400] PubMed/NCBI

[401] Google Scholar

[ref180] 180. Maeda A, Araujo E, Cashin C, Harris J, Ikegami N, Reich M. Universal health coverage for inclusive and sustainable development: a synthesis of 11 country case studies. World Bank Publications. 2014.

[ref181] 181. Nundy M, Bhatt P. Health System in the Republic of Indonesia: Reforms, Transformations, and Challenges (CSEP Working Paper 43). Centre for Social and Economic Progress; 2022.

[ref182] 182. Sumriddetchkajorn K, Shimazaki K, Ono T, Kusaba T, Sato K, Kobayashi N. Universal health coverage and primary care, Thailand. Bull World Health Organ. 2019;97(6):415–22. pmid:31210679
View Article
PubMed/NCBI
Google Scholar

[405] View Article

[406] PubMed/NCBI

[407] Google Scholar

[ref183] 183. Jabeen R, Rabbani U, Abbas N. Financing mechanisms applied for successful Universal Health Coverage in Malaysia, Thailand and Singapore-lessons for Pakistan. 2021.

[ref184] 184. Adhikari DB. Informal Economy and Poverty in Urban Nepal. Economic Journal of Nepal. 2018;41(3–4):12–24.
View Article
Google Scholar

[410] View Article

[411] Google Scholar

[ref185] 185. Deshpande A, Miller-Petrie MK, Lindstedt PA, Baumann MM, Johnson KB, Blacker BF, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahpour I: Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000–17. The Lancet Global Health 2020, 8(9):e1162-e1185.
View Article
Google Scholar

[413] View Article

[414] Google Scholar

[ref186] 186. Otieno E, Seeiso T, Businge J, Kimera G, Sempira E. Achieving universal health coverage inSub-Saharan Africa through the reformation of mental health financing. GHES. 2024;0(0):3700.
View Article
Google Scholar

[416] View Article

[417] Google Scholar

[ref187] 187. Mandal R, Basu P. Cancer screening and early diagnosis in low and middle income countries : Current situation and future perspectives. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018;61(12):1505–12. pmid:30353287
View Article
PubMed/NCBI
Google Scholar

[419] View Article

[420] PubMed/NCBI

[421] Google Scholar

[ref188] 188. Nugent R, Bertram MY, Jan S, Niessen LW, Sassi F, Jamison DT, et al. Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals. Lancet. 2018;391(10134):2029–35. pmid:29627167
View Article
PubMed/NCBI
Google Scholar

[423] View Article

[424] PubMed/NCBI

[425] Google Scholar

[ref189] 189. Local Burden of Disease HIV Collaborators. Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems. BMC Med. 2021;19(1):4. pmid:33413343
View Article
PubMed/NCBI
Google Scholar

[427] View Article

[428] PubMed/NCBI

[429] Google Scholar

[ref190] 190. Dhimal M, Dhimal ML, Dahal S, Shrestha MP, Gyanwali P, Shao R, et al. Barriers and facilitators to the implementation of a national multisectoral action plan for the prevention and control of noncommunicable diseases in Nepal: perspectives of stakeholders. Glob Health Action. 2021;14(1):1963069. pmid:34448675
View Article
PubMed/NCBI
Google Scholar

[431] View Article

[432] PubMed/NCBI

[433] Google Scholar

[ref191] 191. Kumar A, Schwarz D, Acharya B, Agrawal P, Aryal A, Choudhury N, et al. Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal. BMJ Glob Health. 2019;4(2):e001343. pmid:31139453
View Article
PubMed/NCBI
Google Scholar

[435] View Article

[436] PubMed/NCBI

[437] Google Scholar

[ref192] 192. Freebairn L, Song YJC, Occhipinti J-A, Huntley S, Dudgeon P, Robotham J, et al. Applying systems approaches to stakeholder and community engagement and knowledge mobilisation in youth mental health system modelling. Int J Ment Health Syst. 2022;16(1):20. pmid:35462553
View Article
PubMed/NCBI
Google Scholar

[439] View Article

[440] PubMed/NCBI

[441] Google Scholar

[ref193] 193. Gupta I, Chowdhury S. Correlates of out-of-pocket spending on health in Nepal: implications for policy. WHO South East Asia J Public Health. 2014;3(3):238–46. pmid:28612808
View Article
PubMed/NCBI
Google Scholar

[443] View Article

[444] PubMed/NCBI

[445] Google Scholar

[ref194] 194. Sapkota VP, Bhusal UP. Governance and Purchasing Function under Social Health Insurance in Nepal: Looking Back and Moving Forward. J Nepal Health Res Counc. 2017;15(1):85–7. pmid:28714499
View Article
PubMed/NCBI
Google Scholar

[447] View Article

[448] PubMed/NCBI

[449] Google Scholar

[ref195] 195. Oranje M, Mathauer I. Exploring the effects of digital technologies in health financing for universal health coverage: a synthesis of country experiences and lessons. Oxf Open Digit Health. 2024;2:oqae016. pmid:40230965
View Article
PubMed/NCBI
Google Scholar

[451] View Article

[452] PubMed/NCBI

[453] Google Scholar

[ref196] 196. Wilson D, Sheikh A, Görgens M, Ward K, World Bank. Technology and Universal Health Coverage: Examining the role of digital health. J Glob Health. 2021;11:16006. pmid:34912559
View Article
PubMed/NCBI
Google Scholar

[455] View Article

[456] PubMed/NCBI

[457] Google Scholar

[ref197] 197. Bae G, Kang M, Reich MR. The Consolidation of Risk Pools in the National Health Insurance Program of the Republic of Korea: Analysis of the Political Processes. Health Syst Reform. 2024;10(1):2375101. pmid:39159476
View Article
PubMed/NCBI
Google Scholar

[459] View Article

[460] PubMed/NCBI

[461] Google Scholar

[ref198] 198. Miracolo A, Sophiea M, Mills M, Kanavos P. Sin taxes and their effect on consumption, revenue generation and health improvement: a systematic literature review in Latin America. Health Policy Plan. 2021;36(5):790–810. pmid:33885782
View Article
PubMed/NCBI
Google Scholar

[463] View Article

[464] PubMed/NCBI

[465] Google Scholar

[ref199] 199. Hoe C, Weiger C, Cohen JE. Understanding why collective action resulted in greater advances for tobacco control as compared to alcohol control during the Philippines’ Sin Tax Reform: a qualitative study. BMJ Open. 2022;12(5):e054060. pmid:35636785
View Article
PubMed/NCBI
Google Scholar

[467] View Article

[468] PubMed/NCBI

[469] Google Scholar

[ref200] 200. Capuno J, Ruiz Rivadeneria A, Beazley I, Maeda A, James C. Health financing and budgeting practices for health in the philippines. OECD J Budget. 2018;18(2).
View Article
Google Scholar

[471] View Article

[472] Google Scholar

[ref201] 201. Javadinasab H, Masoudi Asl I, Vosoogh-Moghaddam A, Najafi B. Comparing selected countries using sin tax policy in sustainable health financing: Implications for developing countries. Int J Health Plann Manage. 2020;35(1):68–78. pmid:31273831
View Article
PubMed/NCBI
Google Scholar

[474] View Article

[475] PubMed/NCBI

[476] Google Scholar

[ref202] 202. Jurberg C. Flawed but fair: Brazil’s health system reaches out to the poor. Bull World Health Organ. 2008;86(4):248–9. pmid:18438510
View Article
PubMed/NCBI
Google Scholar

[478] View Article

[479] PubMed/NCBI

[480] Google Scholar

[ref203] 203. Oliveira R, Santinha G, Sá Marques T. The Impacts of Health Decentralization on Equity, Efficiency, and Effectiveness: A Scoping Review. Sustainability. 2023;16(1):386.
View Article
Google Scholar

[482] View Article

[483] Google Scholar

[ref204] 204. Forman RP, Cylus J. Financing for health system transformation: spending more or spending better (or both)?. Copenhagen: WHO Regional Office for Europe. 2023.

Figures

Abstract

Background

Methods

Results

Conclusions

Introduction

Methods

Study design

Identifying research question

Identifying relevant documents

Selection of documents

Extraction and charting of data

Summarizing and reporting the findings

Public and experts’ involvement

Results

Health financing landscape

Health financing functions of social health protection schemes in Nepal

Service coverage

Health system capacity for NCD-related health services.

Health system readiness to address emerging disease burdens.

Constraints of service coverage.

Population coverage

Access to HFs.

Health insurance utilization.

Shifting demographics and disease burden.

Financial coverage

High OOP and financial burden due to NCDs.

Health financing inequities

Disproportionate budget allocation to local governments.

Inequitable financial risk protection in health care.

Discussion

Paradigm shift in health financing system and policy landscape in Nepal

Tax-based versus premium-based health financing models

Aligning health financing with disease burden

NHIP reforms for addressing financial risk protection in healthcare

Maximizing risk pooling by minimizing fragmentation and duplication

Raising revenues for health.

Resource allocation.

Purchasing of health services.

Implications of study for policy, program, and research

Strengths and limitations of the study

Conclusions

Supporting information

S1 Table. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

S2 Table. Search strategy.

S3 Table. Selected documents and reports in the review.

S1 Fig. Health financing policy trajectory of Nepal.

S2 Fig. Health insurance coverage in Nepal.

S3 Fig. Disease burden by age, Nepal (1990–2021).

S4 Fig. Healthcare expenditures for political leaders and power elites during 2013–2022 in Nepal.

Acknowledgments

References