Initiative by the Board to Reduce Expenses and Increase Revenue for Improving Health Insurance

Nepal Health News, Kathmandu – The Health Insurance Board has recently made various decisions aimed at enhancing the effectiveness of the health insurance program by reducing unnecessary expenditures and increasing revenue.

In a board meeting chaired by the Board's Chairperson, Chandra Bahadur Thapa, it was noted that unnecessary tests were leading to inflated insurance claims, creating challenges in payment settlements. To address this, the Board has requested the Ministry of Health and Population to assist in ensuring that only necessary tests are conducted and that treatments follow established protocols.

The Board also pointed out that claims are being made under the health insurance program for services already covered by the government under basic health care funding. To eliminate this duplication and reduce financial liabilities, the Board has requested support from the Ministry. Experts have concluded that although the government allocates separate funds for basic care, submitting the same claims under insurance leads to duplication.

In response to the Board’s request, Health and Population Minister Pradeep Paudel has already formed a recommendation task force to fully implement treatment standards and eliminate duplication.

The Board believes that if all government-supported health assistance programs could be integrated under the Health Insurance Fund, it would not only remove duplication but also help reduce costs. Executive Director Dr. Raghuraj Kafle stated, “Programs like the Treatment Fund for Underprivileged Citizens (Directive 2080) and the Mother and Newborn Protection Program (2078) show that integrating them into the insurance system would enhance service delivery and efficiency.” He added that a proposal has been sent to the Ministry of Health and Population to make health insurance mandatory for targeted groups. Currently, the government provides separate payments under each of these programs.

As a new source of income, the Board has proposed that a fixed percentage of the expenses of all pharmaceutical companies operating in Nepal be contributed to the Health Insurance Fund. The Board has communicated with the Ministry of Health and Population to support this proposal, according to Executive Director Dr. Kafle.

To further increase revenue, the Board has requested government approval to run a Health Insurance Lottery program. Such lotteries are practiced in various countries and are believed to be effective in raising funds.

Moreover, the Board has proposed that a fixed portion of the revenue the government collects from the production and consumption of goods that negatively impact public health—such as medical equipment, recharge cards, digital banking services, airline tickets, alcohol, sugar-based products, and petroleum—should be allocated directly to the Health Insurance Fund. The Board has requested the government to make necessary arrangements for this.

Previously, based on the Board’s recommendation, Health Minister Pradeep Paudel decided that 1% of the income generated by all federal hospital development committees should be directly deposited into the Health Insurance Fund.