Health insurance: Boon for patients, burden for hospitals

By Raju Lamichhane,Rukum West, Jan. 4 : The government-run health insurance programme in Rukum West has provided much-needed financial relief to patients. However, the hospitals are struggling with unpaid reimbursements.

According to the Health Insurance Board, a total of 85,788 individuals from 20,884 households in the district’s six municipalities are enrolled in the health insurance scheme. 

District Coordinator Kamal Dangi highlighted that primary service points have been established at District Hospital Salle, Chaurjahari Hospital, Primary Health Centre Kotjahari, Sahid Smriti Nagar Hospital, Aathbiskot Municipal Hospital and Sanibheri Rural Municipality Hospital to facilitate the programme.

Despite serving thousands of insured patients, hospitals have reported delayed reimbursements amounting to Rs. 91.86 million. 

Dr. Mahesh Chaulagain, Chief of District Hospital Salle, stated that Rs. 12.5 million in reimbursements is pending, including Rs. 2.3 million from the previous fiscal year and the entire amount for the current fiscal year 2025/26.

Chaurjahari Hospital, which provides the highest volume of services through health insurance, reported dues of Rs. 55.36 million. 

Hospital Administrator Dil Bahadur Giri revealed that pending payments since April last year have led to significant operational challenges, including delays in salary payments to 125 staff members. 

The hospital serves over 100,000 patients annually, with 74 per cent receiving treatment under the health insurance scheme.

Other hospitals are facing similar issues. Sahid Smriti Nagar Hospital in Chaurjahari has Rs. 5.56 million in pending payments since April last year.

Primary Health Centre Kotjahari has Rs. 26,500 overdue, while Aathbiskot Municipal Hospital is awaiting Rs. 15.1 million. 

Similarly, Sanibheri Rural Municipality Hospital has to recover Rs. 3.31 million, according to its Chief, Karna Bir KC.

Despite these financial challenges, District Coordinator Dangi praised the programme, which has been operational since May 15, 2017, for its impact at the community level. 

The government offers free health insurance to senior citizens, individuals with ‘Category A’ disabilities, and HIV-infected persons. Female community health volunteers are also eligible for a 50 per cent discount.

In Rukum West, 4,980 senior citizens, 184 disabled individuals, and 62 HIV-infected persons are benefitting from free health insurance, while 124 female health volunteers have received discounted coverage.