Universal health coverage needs more state support

Nepal's ambitious goal of achieving universal health coverage by 2030 through its National Health Insurance Programme (NHIP) appears increasingly unattainable due to persistent issues. Introduced in 2017, the NHIP faces significant challenges including structural weaknesses, weak governance, and most critically, chronic underfunding. These problems have led to a sharp decline in the program's popularity, with renewal rates dropping to approximately 50 percent.

Recent government actions have further exacerbated the situation. In January, the outpatient department (OPD) ceiling for families was drastically reduced from Rs100,000 to Rs25,000. More recently, the Health Insurance Board halted outpatient services at private hospitals, citing financial burdens. This has resulted in overwhelming patient numbers at state-run hospitals like Bir Hospital and Tribhuvan University Teaching Hospital, leading to overcrowding and delays in essential services.

Consequently, patients are now forced to pay exorbitant fees at private hospitals despite having paid their insurance premiums. State-run hospitals are also struggling, as they have not received insurance coverage fees from the government and lack many medicines covered by the scheme, forcing patients to seek expensive pharmacies. This situation suggests Nepal has failed its citizens by offering a health scheme that no longer provides adequate coverage, breaking the fundamental trust inherent in insurance. Officials' lack of concern over declining renewal rates, viewing it as a reduction in the board's burden, raises serious questions about the commitment to universal health coverage.