Nepal’s national health insurance scheme is facing a deep crisis, with major hospitals halting or limiting services, leaving thousands of patients struggling to access care.
Several key state-run institutions, including Teaching Hospital and the Manmohan Cardiothoracic Vascular and Transplant Centre, have stopped providing services under the scheme for months. Others, such as Bir Hospital and Shahid Gangalal National Heart Centre, are offering only limited care, mostly restricted to outpatient services.
The Health Insurance Board is receiving over 80 complaints daily from patients who are denied treatment despite being enrolled in the programme. Many are being asked to pay out of pocket for medicines, lab tests, and even surgeries. Patients have also reported delays, unequal treatment, and long waiting times.
At the core of the crisis is a financial dispute. Hospitals say they have not been reimbursed for services provided, while the board maintains that payments are ongoing but delayed. Outstanding dues to hospitals have reached around Rs16 billion and continue to rise.
Although the government has already disbursed around Rs14 billion, including public contributions and budget allocations, officials say an additional Rs6 billion is urgently needed to stabilise the system in the short term.
The programme, designed to ensure universal health coverage, currently serves around 50,000 people daily and covers more than 10 million citizens. However, recent cuts, including a reduced ceiling for outpatient services, have raised concerns about the government’s commitment.
Experts warn that declining trust in the system could discourage people from renewing their policies, further weakening a programme that was once seen as a cornerstone of public healthcare reform.