Impact Evaluation of Nepal District Health Insurance Pilot 2014, Baseline Survey
Other Household Health Survey [hh/hea]
The Nepal Ministry of Health and Population has been working to develop a national health financing strategy in order to realize Nepal's vision of universal coverage. A parallel effort is ongoing to pilot a health insurance that will address rising out-of-pocket health expenditures and increasing lack of coverage for the poor.
The primary objectives of the impact evaluation are to:
1. Evaluate the effectiveness of the health insurance pilot for the at-risk population
2. Conduct a process evaluation of the health insurance to illuminate potential constraints and incentive problems to inform the national scale-up
3. Provide cost analysis data to inform decisions relating to coverage limits and price negotiations and to estimate the cost-effectiveness of results for the national scale-up.
The results of this evaluation will be used to inform the design and implementation of Nepal's national health coverage plan.
This evaluation consists of six treatment districts, where the new health insurance scheme will be rolled out.
The impact evaluation of provision of new health insurance scheme will be primarily based on a randomized enrolment promotion/encouragement design targeted to increase take up rate of the new health insurance product. However, since the feasibility of this method in identifying the impact is highly dependent on the efficacy of the randomized encouragement on the take up of health insurance, a provision also is made to incorporate a quasi-experimental design which could be utilized for assessing the impact in case the randomized encouragement design does not result in sufficient take up differential. Specifically, under such conditions, a matched difference-in-difference design will be used for impact evaluation. Thus, the evaluation will combine both experimental as well as quasi-experimental designs, where the experimental design will be given priority over the quasi-experimental design.
The baseline community and household surveys were conducted between March and May 2014. Encouragement intervention and implementation of the program were done in June-July 2014. The process evaluation was planned for June 2014 - January 2016, and the endline survey should be carried out in February 2016.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
v01, edited datasets with removed values for variables - direct identifiers.
The scope of the study includes:
- household roster
- labor status, education
- housing conditions and physical facilities
- household assets, income
- land ownership and livestock
- health related financial shocks
- food and non-food consumption
- borrowing and savings
- health status and utilization
- risk preference
- access to basic services and community characteristics
- social capital and community empowerment
- community programs
- health insurance
Six districts: Ilam, Baglung, Kailali, Udaypur, Gorkha and Kapilvastu
Producers and sponsors
Alemayehu A. Ambel
Tekabe Ayalew Belay
Strategic Impact Evaluation Fund
Recognizing the challenge in identifying households to be targeted for health insurance, the pilot will use proxy means testing as a targeting tool to identify households.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
The 153 Village Development Committees (VDCs) in the 6 districts will be randomly assigned to treatment and control group where the treatment VDCs will receive enrollment encouragement intervention. Approximately half of these VDCs will be randomly assigned to a treatment group that will receive the promotion and other half will be assigned to a control group which will not receive any such promotion.
The differences in take-up rates between the treatment and control VDCs is the estimates of the effect of the encouragement mechanisms on the take-up rate.
In addition to the primary data collection at the household level, existing data sources including the Health Management Information System (HMIS) which provides regular monitoring data, service tracking surveys, and household surveys will be used. The recently conducted Nepal Living Standard Survey and Nepal Demographic and Health Survey will be used to match the districts and verify the robustness of the evaluation design. Data from HMIS will also be used for regular monitoring of the implementation of the intervention.
The evaluation will also include the collection of cost data, which will be combined with the impact estimates to assess the cost-effectiveness of the intervention and fiscal implications of taking it to scale.
The evaluation will assess the intervention impact along four indicators:
- utilization of inpatient care
- utilization of outpatient care
- out-of-pocket expense
- drug stockout.
Full Bright Consultancy (Pvt.) Ltd., Kathmandu, Nepal
Alemayehu A. Ambel
DECDG - Development Data Group, World Bank
Tekabe Ayalew Belay
GHNDR - Health, Nutr & Population - GP, World Bank
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download.
Alemayehu A. Ambel, Ilana Seff, Tekabe Ayalew Belay, World Bank. Impact Evaluation of Nepal District Health Insurance Pilot 2014 (DHIPIE-BL), Baseline Survey. Ref. NPL_2014_DHIPIE-BL_v01_M. Dataset downloaded from [URL] on [date].
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
DDI Document ID
Development Data Group
Documentation of the study
Date of Metadata Production
DDI Document version
- v02 (June 206)
Dataset "community_public" and Community Questionnaire added