Health Insurance Scheme faces Rs 25.26bn deficit despite rapid growth
Summary
Nepal's national health insurance programme has grown significantly but faces a Rs 25.26 billion funding shortfall with only 60% active membership and high utilization rates.
Key Points
- Nepal's national health insurance has expanded to nearly 9.8 million enrolled members across all 77 districts since 2016.
- Only about 60% of enrolled members remain active, with high utilization of about 92% among active members.
- The programme faces a projected Rs 25.26 billion funding deficit next fiscal year, with average daily claims at Rs 8 crore.
- Policy reforms include outpatient service ceilings, coverage expansion for chronic illnesses, waiting periods, and co-payment mechanisms to improve sustainability.
