What Is the Process for Restructuring the Health Insurance Program?

The government is preparing to restructure the health insurance program to reduce its financial burden and improve service effectiveness. With more than NPR 1.6 billion in outstanding payments by the Health Insurance Board, an annual expenditure of NPR 2.5 to 2.6 billion has been required. The restructuring plan aims to reduce financial strain, prevent leakages, improve the co-payment system, and revise the service package. April 12, Kathmandu.

The government is undertaking a restructuring of the health insurance program to address financial challenges, leakage, and management problems, ensuring its sustainability and long-term viability. President Ram Chandra Paudel mentioned the health insurance restructuring in his policy and programs speech for the upcoming fiscal year during the joint session of the Federal Parliament. A senior official from the Ministry of Health and Population stated that although restructuring is mentioned in the policy documents, a detailed action plan is currently under development.

The primary objective of the restructuring is to reduce the existing financial burden within the insurance system, enhance service effectiveness, and enable citizens to more easily access services beyond basic health care. The main cause of the high financial burden is the economic imbalance within the system, where the government holds significant fiscal responsibility for program operation. Service provider hospitals have faced difficulties in recovering millions of rupees, leading to diminishing program effectiveness.

Controlling leakage and duplication is another important aspect of the restructuring. Currently, unnecessary tests and duplicated services at various hospitals, combined with weak management, result in significant expenditures. According to the ministry official, strict measures will be implemented to stop such leakages and improve service management. Furthermore, the ministry source indicated potential improvements in the co-payment system to ensure the program’s sustainability.