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Constitution of Nepal has recognised basic health services as a fundamental human right. Implementing health insurance will be an important vehicle to achieve Nepal’s aim of universal health coverage. Nepal in recent years has seen considerable improvement in the health status through rich network of healthcare institutions complimented by private sectors. But they are mostly centred in urban area, hence, health access and equity remain a challenge. Community-based health insurance started long back but failed. Social health insurance is at inception with challenges of varying degrees for its successful implementation and bringing equity in health and achieving universal coverage. There are histories of success and failure around the globe in adopting various models of health insurance. Various concerns comprise governance, strengthening of primary healthcare setup, quality assurance, proper identification of poor, single pool of fund, financing, enrollment option, retention, human resources, medicines and equipment, third party administrator, monitoring and evaluation, etc. Disappointment due to any shortcomings of the programme can decrease enrollment and service utilisation and ultimately, the programme may fail. Rigorous discussions and debates on minute details of every aspect, adopting models and right actions pertinent to our circumstances and suitability for a sustainable yet attainable model is needed.

Health equity; international experiences; Nepal; social health insurance; universal health coverage.