KATHMANDU: Nepal’s health insurance program, designed to provide citizens with quality and accessible treatment, is facing a serious crisis due to financial imbalance and policy weaknesses. Several major hospitals have suspended services, leaving patients stranded and raising questions about the program’s sustainability.
Tribhuvan University Teaching Hospital (TUTH) has stopped all insurance-based services from January 15, citing unpaid claims amounting to nearly Rs 400 million . The Manmohan Cardiothoracic, Vascular and Transplant Center, located within TUTH, has also halted insurance services. Earlier, hospitals including Gangalal warned of suspending insurance-based treatments due to delayed payments.
The program’s executive director, Dr. Raghuram Kafle, resigned, citing insufficient funds to make timely payments to service providers. Dr. Krishna Prasad Paudel, the new acting executive director, said efforts are underway to resume the halted services.
The suspension at major referral hospitals such as TUTH has increased pressure on Bir Hospital, as patients seek alternative care there. Bir Hospital officials report rising patient loads in OPD, emergency, surgery, and specialist services, particularly from those relying on health insurance. Dr. Anil Baral noted that many patients referred from TUTH have strained hospital staff and resources further.
Health Ministry commitment
Health Minister Dr. Sudha Sharma acknowledged the severe financial imbalance in the health insurance program and emphasized the ministry’s efforts to strengthen its effectiveness. She admitted that delayed payments have weakened services and stated that while immediate resumption of services is a priority, long-term solutions require policy reforms.
To address the immediate crisis, the ministry has requested Rs 1 billion from the Finance Ministry, though experts call it a temporary relief. The board’s data shows that the Rs 10 billion allocated in the current fiscal year was exhausted within the first four months, with about Rs 11 billion still due to 510 service providers. Previous subsidy demands have also not been fully addressed.
Board response
The Health Insurance Board said it is actively working to restore services, particularly in hospitals that have suspended insurance-based treatment. “We are in continuous dialogue with TUTH and other major hospitals regarding pending payments,” said board spokesperson Bikesh Malla.
Malla added that discussions with the Ministry of Health and Finance are ongoing, aiming to ensure uninterrupted services for the one million people covered under the program.
A recent high-level meeting included Dr. Krishna Prasad Paudel (Health Insurance Board), Prof. Dr. Subash Prasad Acharya (TUTH), and Prof. Dr. Ratnamani Gajurel (Manmohan Cardiothoracic, Vascular and Transplant Center). The meeting focused on necessary policy reforms, strengthening a scientific and transparent claim assessment system, and improving coordination and collaboration between the board and hospitals.
The board confirmed that stakeholders have expressed a joint commitment to resume health insurance services promptly and agreed to implement policy reforms, strengthen claim evaluation mechanisms, and enhance cooperation to ensure effective program delivery.
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