Koshi Hospital in Financial Crisis, Insurance Board's Decision Severely Affects Services
Nepal Health News, Biratnagar – Koshi Hospital, located in Biratnagar and the largest government health institution in Koshi Province, is currently facing an existential crisis due to a recent decision by the Health Insurance Board. The Board has decided to remove Koshi Hospital from the list of ‘first point of service’ facilities starting from Shrawan 1 (mid-July), sparking serious concerns about the financial and administrative impacts of the move.
Previously, patients could directly seek treatment at Koshi Hospital under the health insurance program. However, under the new system, patients will now be required to obtain referrals from local health centers before receiving treatment at the hospital. This change is expected to not only inconvenience patients but also significantly affect the hospital’s revenue. According to hospital administration, this decision could lead to an annual income loss of nearly NPR 200 million.
Even now, a majority of patients who receive daily services at Koshi Hospital are enrolled in the health insurance scheme, with many choosing it as their primary point of care. With the removal of the hospital from the insurance network, over 100,000 insured residents of Biratnagar Metropolitan City will be forced to visit the Rani Primary Health Center for referrals. However, that center lacks the infrastructure and workforce to handle such a large influx of patients.
Koshi Hospital currently employs 376 staff, with monthly expenses, including salaries and allowances, reaching up to NPR 15 million. These costs have so far been managed through the hospital’s internal income. But with the expected loss of insurance-based revenue, the hospital will struggle to pay staff salaries and cover operational expenses.
In this fiscal year alone, the hospital has already claimed over NPR 280 million from the Health Insurance Board for treatment provided to insured patients. However, only NPR 8.5 million has been reimbursed so far. With the remaining payments still pending and the new decision in place, the hospital's services are now at serious risk.
From hospital administrators to local representatives, the decision has been met with strong criticism. Mahesh Bhattarai, Chairperson of the Koshi Hospital Development Committee, stated that this move is equivalent to shutting down the hospital. Federal MP Amanlal Modi raised the issue in the House of Representatives, calling it an anti-public decision influenced by vested interests in the private healthcare sector.
There is widespread dissatisfaction, with critics accusing the government of reversing its responsibility to ensure access to healthcare and instead promoting bureaucratic hurdles that favor private institutions. Dr. Runa Jha, Chief of Koshi Hospital, has also appealed to the Board and the Ministry to review the decision.
Ultimately, this controversy is not limited to Koshi Hospital alone; it is tied to the broader public health system, the access of insured citizens, and the survival of government hospitals across the country. If the goal of the health insurance program is to provide affordable and accessible care to the general public, this decision appears to be moving in the opposite direction.
