Nepal and India Health Economics Evidence Base: Systematic Literature Review of Health Financing, Out-of-Pocket Payment, Financial Protection, Health Insurance, and Economic Evaluation

Abstract

Background: The field of health economics is associated with effective allocation of resources aimed at maximizing health gains, healthcare access, and financial protection. Despite the presence of many similar features between Nepal and India in terms of geography, population, economy, and other issues, the health financing systems of these countries significantly differ from each other. Both Nepal and India are characterized by high rates of OOP payments, health inequities, emergence of NCDs, and UHC achievement.

Objectives: The goal of the current study is a systematic comparison of the health economics evidence base in Nepal and India concerning health spending, OOP expenditure, catastrophic health expenditure, health insurance, financial protection, health technology assessment, and economic evaluation.

Methods: The literature search was performed in the scientific databases such as PubMed and PubMed Central, and also other reliable health sector sources. Priority was given to the research papers published in the period from 2021 till 2026 and having DOI. The articles associated with health financing, household expenditures, insurance, economic evaluation, health technology assessment, and UHC were included into the research. The results are presented in a narrative manner because of the diversity of methodologies, populations, outcomes, and measurement approach used in the literature.

Results: It was found out that OOP expenditure is still one of the main health economic problems in Nepal and India. In general, the country that has more developed evidence base in relation to economic evaluation and health technology assessment is India due to the presence of specialized institutions and health insurance systems. Nepal has achieved certain progress in terms of implementing the national health insurance and social protection schemes; however, they are characterized by such problems as risk pooling fragmentation, coverage issues, etc. Moreover, the burden of hospitalization caused by chronic diseases exists in both countries.

Conclusion: Both Nepal and India have achieved certain progress in the direction of UHC; however, the issue of financial protection remains unresolved. India has much potential in relation to conducting health technology assessment and economic evaluation due to the presence of appropriate institutions. Nepal should develop its evidence base, implement strategic purchasing, and conduct economic evaluations.

Novelties: The review covers the evidence bases in Nepal and India and makes comparisons in terms of health economic challenges and opportunities.