Table 1 List of studies for legal assurance, risk pulling and financing of health service in Nepal 2002–2018: a systematic review, Nepal, 2018

1

Interim constitution of Nepal [42]

The bill related to health insurance has amended but preparing the modality and scheme became very complex.

Health is accepted as fundamental human right and government must provide basic health service to all citizens.

2

National Health Insurance Policy 2013 [43]

There are many interest groups to dismiss the social health insurance program in Nepal.

Platform has been established to freely discuss the impact of social health insurance.

3

Pokhrel Rajani and Silwal Puskar. Social health insurance in Nepal: A health system departure toward the universal health coverage [44]

Very poor coverage (5% population coverage) of social health insurance in Nepal.

Social health insurance program has been extended and benefit package has been revised.

4

Review of community-based health insurance initiatives in Nepal [45]

Isolated, localized CBHI schemes, as presently implemented in Nepal, do not constitute well accepted model on which national health insurance could be successfully raised.

The positive environment for health insurance has been created by public and health experts.

5

National health insurance policy in Nepal: challenges for implementation [46]

The enrollment status is very low and health workers have no special training.

Training for financial management, application of information technology has been started in hospital health insurance.

6

Implementing a Participatory Model of Micro Health Insurance among Rural Poor with Evidence from Nepal [47].

The participation is volunteer based, premium amount could not pay by poor people and high dropout in current enrollment.

The health insurance is toward mandatory health insurance to all citizen and foreigners too.

7

A Comparative Study on Outcome of Government and Co-Operative Community-Based Health Insurance in Nepal [48]

There is poor awareness on contribution based health service in Nepal.

Community organization like Co-Operative groups can be utilized for universal health insurance coverage.

8

Progress Report on Opportunities, Challenges, Lessons Learned and Strategic Directions for the Implementation of the Nepal Health Sector Programme-2 [49]

There are not enough discussion with interest groups about the health insurance service and payment models.

The social health insurance manual is under discussion with the different stakeholders.

9

E Saito et. al Catastrophic household expenditure on health in Nepal: a cross-sectional survey [50]

The catastrophic health spending is more (13%) than threshold level (10%) in household level and majority of causes are road traffic accident and foreign employment.

Health insurance program by hospital and coverage area has been expanded and disease specific health insurance program has been started.

10

Uprety Sudeep and Lamichhane Bipul 2016. Health Budgeting and Financing in Nepal: Policy Perspectives [51]

There is no assurance for sufficient financing, equitable and efficient resources and financial management and accountability.

Health financing policy discourse has been started.

11

The Current Trade Union Situation in Nepal [52]

Seriously misleading of trade union as a sister organization of political parties and diverting the goal of labor organizations ignoring the issue of financial protection during illness.

Trade Union could strongly advocate the mandatory health insurance of labors and their families to their companies

12

Nepal Labour Market Profile 2014 [53]

Informal market is the main challenges to collect health insurance premium.

Large numbers of youth are outside the countries and can be converted into formal labor market.

13

There is high priority of Universal health coverage in UN sustainable development goal globally [54]

There is no clear paradigm shift to achieve UHC and international support modality has not designed clearly.

There is a global pressure and environment to achieve UHC.

14

Health Federalism: The Role of Health Care Professionals in Nepal [55]

The high amount of out-of-pocket expenditure is increasing due to conflict of interest in health care system and professionals who involve government health system of Nepal.

Health professional councils could involve making health care system like Universal Health Coverage.