Nepal will soon restructure its national health insurance programme to ensure that it remains sustainable, and misuse of the health insurance funds is prevented.
Nepal's Finance Minister Dr Swarnim Wagle has said that the health insurance restructuring exercise would be taken up via the Budget for the financial year 2026-2027, which begins from 16 July 2026. Nepal's financial year runs from 16 July of the current year to 15 July of next year, according to the Gregorian calendar.
According to media reports, Dr Wagle was recently addressing a meeting of the Development, Economic Affairs and Good Governance Committee under the National Assembly, when he said that the health insurance programme is not sustainable in its current modality and preparations are being made to restructure it and move forward.
Dr Wagle said, “We have not been able to invest in health insurance in a very generous manner as per the expectations of the people, and there is also a lot of misuse, therefore, we are restructuring this programme.
"If we do not restructure it, it will definitely collapse. Therefore, we will implement it in a way that the basic healthcare need of the poor people is met but based on contributions from those who can afford it. It has to be made like insurance.”
He said that although NPR10bn ($66m) was allocated for health insurance last year, claims of up to NPR30bn have been received and it has become difficult to pay.
He said unnecessary tests and misuse have increased in private hospitals; hence, there is a need to 'right-size' the programme.
He also stated that since basic healthcare is the right of the poor, the government will protect them. He said the citizens will be brought into a contribution-based insurance system.
Health insurance will be restructured into three tiers, establishing a sustainable system with government support for the poor, contribution-based services for the middle class, and mechanisms to control misuse.
The Finance Minister said the government is positive about allocating a portion of taxes on items like cigarettes and alcohol to the health insurance fund.