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Umesh Prasad Bhusal, Vishnu Prasad Sapkota · 2021 · BMJ Open

Nepal's NHIP has achieved geographic reach — enrolling in all 753 local governments — but this study reveals only 6.95% of households were enrolled as of 2019, with coverage disproportionately concentrated among wealthier, more educated, and higher-caste households. The Health Insurance Board (HIB) subsidises premiums for ultra-poor households, yet Dalit and poorest-quintile households remain systematically under-enrolled. With OOP spending at ~51% of total health expenditure and 1.7% of the population pushed below the poverty line annually by health costs, these findings point to urgent equity gaps in financial protection that HIB's current targeting strategy is failing to close.