Reviving Nepal’s Health Insurance Scheme

The decision by leading government hospitals such as Tribhuvan University Teaching Hospital and Shahid Gangalal National Heart Centre to suspend services under the national health insurance scheme has exposed the deep crisis facing one of Nepal’s most ambitious social welfare programmes. Hospitals cannot continue providing services indefinitely when the government fails to reimburse them for months. This is not simply an administrative lapse; it is a failure of the state’s responsibility to guarantee citizens’ access to healthcare. Yet, amid this crisis, there appears to be an opportunity to give the health insurance scheme a new lease of life. Reports that the government is considering channeling taxes collected from tobacco, alcohol and sugary products directly into the health insurance fund offer a potentially transformative solution. If implemented seriously and transparently, this measure could help rescue a programme that millions of citizens increasingly depend upon. Nepal introduced the Social Health Security Programme in 2015 with the goal of ensuring universal access to quality healthcare. The programme, institutionalised through legislation in 2017, was envisioned as a major pillar of social protection. Today, however, it is struggling to survive. Although nearly 50,000 people reportedly receive services daily through the scheme, the Health Insurance Board owes hospitals around Rs 10.5 billion in unpaid claims. Government officials themselves admit that weak management, financial shortages and widespread misuse have pushed the programme to the brink.