Experts have raised concerns about Nepal’s Health Insurance Program which is struggling financially, with NRs 18 billion in unpaid dues and rising monthly claims.

The Program, initiated in 2016, has significantly improved access to healthcare services nationwide. However, it is now struggling with a serious financial crisis, as unpaid hospital claims have reached NRs 18 billion.

The Health Insurance Board (HIB), which oversees the program, has not been able to clear mounting dues to hospitals, mainly due to delays in government funding.

According to the Health Insurance Board’s data, an insured family under the Health Insurance Program pays NRs 3,800 annually on average but receives benefits worth NRs 8,250.

Despite a recent government payout of NRs three billion, a large funding gap remains. The program is vital for the poor, but limited coverage, poor oversight, and high usage driven by over-treatment and inflated claims are pushing it toward collapse.

The Board owes NRs 18 billion to hospitals. The debt is rising by NRs two billion each month and there are not enough funds. As shutting down the program is not an option, the board must come up with a sustainable solution.