PERSPECTIVE article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1609219
This article is part of the Research TopicPublic Health Outcomes: The Role of Social Security Systems in Improving Residents' Health WelfareView all 58 articles
Reconfiguring Health Purchasing for Universal Health Coverage: Insights from Nepal with Relevance to Low-and Middle-Income Countries
Provisionally accepted
- 1University of North Texas, Denton, Texas, United States
- 2Ministry of Health and Population, Nepal, Kathmandu, Nepal
- 3Janamaitri Foundation, Institute of Health Sciences, Lalitpur, Nepal, Lalitpur, Nepal
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Nepal's transition to federalism and the rollout of the National Health Insurance Program (NHIP) marked critical steps toward universal health coverage. Yet, structural misalignments between health financing policies and purchasing practices persist, weakening the effectiveness of these reforms. Strategic purchasing-a key lever in health financing-has the potential to improve system efficiency, equity, and responsiveness by actively allocating pooled funds based on population needs, provider performance, and service value. However, in Nepal, legacy practices such as line-item budgeting, fragmented programmatic funding, and overlapping institutional roles hinder the adoption of this approach. The Ministry of Health and Population continues to play simultaneous roles as policymaker, purchaser, and provider, weakening accountability and the purchaser's autonomy. Public providers are funded through both historical budgets and reimbursement schemes, diluting incentives for performance. Moreover, NHIP's purchasing decisions are not guided by health technology assessments or cost-effectiveness analysis, raising concerns about the allocative efficiency of the benefit package. This Perspective argues that Nepal's health financing reforms require institutional realignment, clearer role demarcation, and stronger contractual mechanisms to support strategic purchasing. Drawing on both national experience and international frameworks, it highlights the systemic disconnects and offers a way forward for embedding strategic purchasing into Nepal's health financing architecture. By correcting these foundational misalignments, Nepal can better leverage public resources to deliver high-quality, equitable care, advancing the goals of federalism and universal health coverage simultaneously.
Keywords: Strategic purchasing, Health financing, Low-and middle-income countries, Institutional reform, Public HealEconomics Hospital
Received: 11 Apr 2025; Accepted: 02 Jun 2025.
Copyright: © 2025 Sriram, Adhikari and Saud. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Saroj Adhikari, Ministry of Health and Population, Nepal, Kathmandu, Nepal
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