The Nepalese government's National Health Insurance Programme that provides accessible, affordable and quality healthcare to citizens, is facing a major crisis as more than three dozen private and community hospitals across the country have stopped insurance-based services.
The scheme, introduced in 2016, caters to millions of Nepalese citizens, especially those at the lower margins of society. The suspension has directly affected millions and pushed them into financial distress.
According to a news report in the English news portal Khabarhub, the Health Insurance Board (HIB) has acknowledged that it owes healthcare providers nearly NPR11bn ($77m) in unpaid claims. Hospitals say they have been forced to halt services under the insurance scheme after failing to manage medicines, medical equipment and human resources due to non-payment.
Meanwhile, the Health Insurance Board has said that the government has not released the required budget in time. The Ministry of Health and Population, however, said the problem has cropped up due to weak management and poor planning by the HIB.
According to HIB, nearly 92% of those enrolled in the scheme are currently using services, creating pressure on limited financial resources. Hence, there is a need to revise premium rates and introduce an income-based premium payment system.
The programme has often been criticised as it is operated more like a social welfare scheme rather than a sustainable insurance system. According to HIB, the arrears that are payable to the private healthcare providers could total NPR26bn by the end of 2026.