Kathmandu. Most of the service seekers have unpleasant experience with the health insurance program being run by the Government of Nepal. The general public is facing a lot of problems due to lack of one-door service in the enlisted institutions and no tests or medicines considered essential for treatment.
The government, which is running the health insurance program under the social security program, has to bear the burden of not being able to bear the cost of this program. The amount claimed by the enlisted health institutions is many times more than the insurance premium income from the program. Minister for Health Pradeep Poudel has expressed his displeasure that the programme cannot be implemented in the current situation.
After spending on food and education, a large part of people’s income is also spent on medical treatment. In such a situation, it may be easier for the general public to manage expenses through health insurance. Private sector health insurance companies can be an appropriate option for the general public who want to consume health treatment quickly and easily as the government programs are very cumbersome.
The government has created seven new insurance companies in the name of micro insurers to mimic the traditional insurer’s business in Nepal. These insurance companies are struggling due to the inability to do any new work and the compulsion to lose capital and resources from many times large insurers. Among these insurers, if specialized insurers could be licensed for agricultural insurance and health insurance, the general public would have got specialized services, while the micro insurers would not have to compete unnecessarily with large insurers.
खर्च Health Insurance Board: ##inline_tags_PLACEHOLDER_10#
According to a white paper issued by the Health Insurance Board, around 30,000-40,000 claims are received daily from service providers. These claims are worth around Rs 70 million. However, the insurance board has the capacity to verify only 6,000-7,000 per day. The delay in the payment of claims from the board blocks the resources to purchase medicines and equipment needed to treat patients in health institutions, especially in government and community hospitals, and ultimately deprives patients of services.
Health Minister Pradeep Poudel has also warned that the program will be closed if the claims are made in the current situation and the board’s income is not increased. The question of how many years or months the government, which is in a position to raise internal debt even for the operation of daily activities, will be able to continue the health insurance program for how many years or months.
The renewal rate of the health insurance program is also very disappointing. Based on the data released by the board, its renewal rate is limited to only 40 percent.
छिमेकी Country India’s Health Insurance:
Health insurance has started contributing significantly to the growth and expansion of the non-life insurance market in the insurance market of neighboring India. According to data published by the Regulatory, Insurance Regulatory and Development Authority, health insurers have achieved a significant growth rate of 15.99 percent during the last fiscal year 2025 (April 2024 to March 2025). Health insurers, which account for 12.5 per cent of the non-life insurance business, collected Rs 384 billion last year. This transaction issue does not include the insurance premium for the Ayushman Bharat (Health Insurance) program being run by the government under the Social Security Program.
##inline_tags_PLACEHOLDER_8#weaknesses of #सरकारी insurance program:
While private sector health insurance grew by nearly 16 per cent, the Government of India’s insurance premium income under the Ayushman Bharat (Health Insurance) programme declined by 9.7 per cent for easy access to health care for the general public.
According to the #inline_tags_PLACEHOLDER_35 ##विज्ञप्ती released by the Press Information Bureau India on April 5, 2025, 500 million Indians have joined the health insurance program implemented in 34 states and union territories of India.
Although the Government of India claims that this program will bear the cost of all types of treatment facilities, the patients get the service under this program only if they are admitted to the hospital and treated. This program has not been implemented for outpatient patients.
While the state-run media continues to make such claims, PolicyCircle.org has released प्रतिवेदन pointing out several weaknesses of the government health insurance programme in India and raising doubts about its long-term continuity. “The real story drawn from parliamentary reports, state-level protest demonstrations and continued exits by private healthcare providers paints a picture of a scheme that is weighed down by its own weight,” the report said.
Since its inception in 2018, more than 600 private hospitals – including some of the most important secondary and tertiary care institutions – have opted out of the insurance program. The status of implementation of insurance programmes in Gujarat, Kerala and Maharashtra is shameful. The report says that the main reasons for all this, delay in admissions, low treatment cost limits, and the opaque nature of claim approvals, especially small hospitals, are struggling hard to keep the program running.
The Haryana chapter of the Indian Medical Association (IMA) has discontinued the Ayushman Bharat Health Insurance Programme after the government failed to pay rs 40 billion claim.
