The Ministry of Health and Food Hygiene has stated that it is actively working on developing an action plan by prioritizing improvements to the health insurance program. According to the Health Insurance Board, the estimated amount owed to hospitals providing services under the health insurance scheme exceeds NPR 2.336 billion. “Last year’s budget allocation was NPR 1 billion, and this time there is a possibility of allocating NPR 1.2 billion. This could provide some relief. We are working on clearing the backlog of outstanding payments to hospitals and implementing both immediate and long-term reforms,” said Ministry Secretary Bikash Devkota. “Hospitals are primarily requesting payments of the amounts due. Discussions are ongoing with the Ministry of Finance. Once payments are made promptly, health services will continue without disruption,” he added.
The Health Insurance Board also confirmed that hospitals have demanded payments and are in talks with the ministry. Tribhuvan University Teaching Hospital has reported that it has halted services under the insurance program due to non-payment. Other hospitals, including Patan Health Science Institute and Ganglal Heart Center, along with various others nationwide, are facing difficulties due to delayed payments. The health insurance system, established nearly a decade ago, allows individuals to pay an annual premium of NPR 3,500 for coverage of up to five family members, providing free treatment up to NPR 100,000.
The ministry is actively working to make health insurance services more accessible to hospitals. At a recent program at Bir Hospital, Health Minister Nisha Mehta informed that intensive discussions are underway on how to make health insurance simpler and more user-friendly. She stated, “Health insurance is a complex system. Serious discussions are ongoing to simplify it, and we will share updates soon.” According to Secretary Devkota, the health insurance act mandates mandatory inclusion of all formal sectors, but this has not yet been fully implemented. By preventing unnecessary or duplicate treatments, monthly claims could be reduced by more than half. Therefore, the ministry is finalizing an action plan.
Ministry spokesperson Sameer Kumar Adhikari said, “The action plan will be announced soon. It will focus on how to ensure sustainable financial management and regular payments to hospitals.” He added, “We are reviewing the services included within the insurance packages, discussing which basic government services to integrate with insurance services or keep separate. Negotiations with relevant ministries regarding resource management are ongoing.”
Executive Director of the Nepal Health Insurance Board, Shakuntala Prajapati, identified delayed large payments to hospitals as the primary issue. “Hospitals are complaining about not receiving payments. If the claims were settled on time, health services would have been uninterrupted,” Prajapati noted. The board collects around NPR 400 million annually from premiums, yet monthly claims can reach between NPR 200 million and NPR 250 million. Annual payment claims have reached NPR 2.5-3 billion. After last year’s budget was approved, claims were reviewed. Despite claims being reviewed until the end of Kartik in the fiscal year, NPR 690 million in payments remained outstanding. For the fiscal year 2082/83 from Mangsir to Asar, the estimated required amount is NPR 1.347 trillion, and the total estimated amount needed is approximately NPR 2.336 billion, the board reported. Though about 10 million Nepalese are enrolled in the health insurance program, only 6 million are active members.
Tribhuvan University Teaching Hospital officially withdrew from the health insurance program in Poush of last year. Various other small and large hospitals are also facing issues due to lack of timely payments. The board states that currently, 510 health institutions are affiliated with the health insurance program, including 441 government hospitals, 39 private hospitals, and 30 community hospitals. Doctor Pawan Sah mentioned that the teaching hospital sent a letter to the board stating it is unable to provide services to patients under the insurance due to non-payment. “We had to cease operations, so we sent a letter to immediately terminate the program,” he said. Assistant Information Officer Kaliprasad Rosyar reported that the hospital claims approximately NPR 510 to 520 million from the board, but due to the absence of meetings and unresolved issues, the situation persists. He said, “The problem has been escalated from the minister to the prime minister, but there has been no response so far, and no necessary funds have been allocated. The program remains suspended.”
