This report was produced as a supporting document to assist and adequately inform the Ministry of Health and Population (MoHP), Nepal, in making key revisions to the scopes of existing NHIP and evaluate necessary amendments or considerations on acts, rules, regulations and policies to improve the efficacy of the program and help achieve the holistic vision of safeguarding quality health care in the country. The report lays out the opportunities and shortcomings of the contemporary legislation governing Nepal’s healthcare system, challenges in health insurance policies and management of resources, concerns over the duplication of services across different governmental health institutions, and mechanisms to foster inter-agency collaboration, reform and oversight of the Health Insurance Board and presents its findings with recommendations and conclusions to support evidence-based policy formulation.

In developing the report, the role of Advocate Pramish Khanal who is serving as the Legal Advisor to Honourable Pradip Paudel, the Minister of Health and Population, GoN remained critical. NPF extends its heartfelt appreciation to Advocate Sadichchha Silwal, Mr. Shaksham Shahi, Ms. Ojashbi Ghimire, Mr. Saugat Subedi, Ms. Sabita Sigdel, Ms. Aastha Pokhrel and Mr. Subin Poudel for adeptly synthesizing the research, which we believe will play a momentous role in shaping Nepal’s health policies in the days to come.

The report serves as a foundational resource for introducing necessary reforms to the current National Health Insurance Program (NHIP) and has been prominently referenced in the high-level report presented to the Prime Minister. This collaborative effort underscores NPF’s commitment to advancing evidence-based research and policy advocacy while aiming to foster meaningful reform in Nepal’s healthcare sector. By addressing critical gaps and proposing actionable solutions, the report paves the way for a more inclusive, efficient, and sustainable health insurance system. It is hoped that this initiative will not only guide the Ministry of Health and Population in its decision-making but also inspire further dialogue and collaboration among stakeholders to achieve the broader vision of universal health coverage in Nepal.