Budget to restructure health insurance programme

By A Staff Reporter,Kathmandu, May 23: Finance Minister Dr. Swarnim Wagle has stated that the health insurance programme will be restructured through the budget for the upcoming fiscal year 2026/027.

Addressing a  meeting of the Development, Economic Affairs and Good Governance Committee under the National Assembly, Dr. Wagle said that the health insurance programme is not sustainable in its current modality and preparations are being made to restructure it and move forward.

“We have not been able to invest in health insurance in a very generous manner as per the expectations of the people. Therefore, we are restructuring this programme this time, and there is a lot of misuse, as you all know," Dr. Wagle said. "If we do not restructure it, it will definitely collapse. Therefore, we will implement it in a way that the basic health care need of the poor people is met, but based on contributions from those who can afford it. It had to be made like insurance.” 

He emphasized that although 10 billion rupees was allocated for health insurance last year, claims of up to 25-30 billion rupees have been received and it has become difficult to pay.

Stating that unnecessary tests and misuse have increased in private hospitals, he said that there is a need to 'right size' the programme.

He also stated that since basic health care is the right of the poor, the government will protect them. He added that the citizens will be brought into a contribution-based insurance system.

“The constitution has also mentioned the idea of an equality-oriented society. We have also said that basic health is the right of every Nepali citizen. But that gap has not been met. The way these claims have been made in private hospitals for unnecessary tests, we find it unnatural and this government should increase the Rs. 10 billion to 12 billion this time. There is another claim of 20-25 billion and if we add the old ones, there are several billions, and there are additional billions of liabilities,” he said.

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.

He also stated that the government is positive about putting a portion of taxes on items like cigarettes and alcohol into the health insurance fund.