A Doctor's View from Health Insurance OPD: Bridging Policy and Practice Gaps in Nepal

A middle-aged man sits across the desk in the health insurance OPD, clutching a file filled with reports and a newly issued insurance card. He has traveled from Myagdi, arriving in Pokhara late at night after hours of difficult transit. By morning, he has already stood in a long queue, waiting for his turn with the expectation that his treatment will now be "covered."

But as the consultation progresses, a familiar reality unfolds. The medicines he needs are out of stock under the insurance scheme. Some investigations are not readily available. He is left with a choice: wait, pay out of pocket, or return home untreated. His relief slowly turns into confusion and then frustration.