Minister for Health and Population Predeep Paudel has called on provincial and local governments to take joint responsibility for the government’s health insurance scheme, emphasizing the need for a collaborative approach to strengthen the national insurance fund.

“Health insurance is not only the responsibility of the federal government but also that of provincial and local governments,” said Paudel. “The funds allocated by all three tiers of government for citizens’ healthcare should be utilized to strengthen the insurance fund. This is possible if we work together.”

Paudel made these remarks during an event organized by the Ministry of Health and Population to unveil the report prepared by a committee formed to make recommendations for reforming health insurance. 

Paudel announced that the ministry, in coordination with the Health Insurance Board, has already begun implementing an action plan to reform the system. He also stated that establishing health insurance units at every administrative level will soon become mandatory.

Highlighting the financial status of the Health Insurance Fund, which currently holds Rs 30 billion, Paudel suggested that a one-door financial management system could help eliminate existing shortages. He further revealed plans to increase the health insurance budget from Rs 3 billion to Rs 10 billion in the upcoming fiscal year.

To further reinforce the fund, Paudel proposed allocating a portion of taxes levied on pollution, sugar-based products, tobacco, and alcohol directly to the Health Insurance Fund. “We have initiated efforts to channel tax revenues directly into the fund, ensuring that citizens do not bear an additional financial burden,” he stated. “If this reform is treated as a national initiative rather than just a ministry-level program, the insurance fund can be significantly strengthened, making the health insurance system more effective.”

As an additional funding source, the government plans to cover public employees’ health insurance through the insurance fund. Under this model, government employees would contribute 1% of their salaries, with the government matching the contribution.

The committee, led by Dr. Shambhu Acharya, submitted its report to Minister Paudel on December 31, 2024. The nine-member committee included senior cardiologist Dr. Bhagawan Koirala and newly appointed Executive Director of the Health Insurance Board, Dr. Raghu Raj Kaphle, among others.

Based on the committee’s findings, a detailed action plan was earlier presented to Prime Minister KP Sharma Oli. Both the report and the action plan have now been made public. The government has begun implementing them, according to ministry spokesperson Dr. Prakash Budhathoki.

Key Recommendations of the Report

According to the state-owned news agency RSS, these are some of the recommendations of the report:

- Expanding Insurance Coverage :Revising premium and co-payment models based on affordability and increasing benefit coverage to at least Rs 500,000 per person.

- Integrating Free Basic and Emergency Services : Merging constitutionally guaranteed free healthcare services with the health insurance system. Redesigning premium structures and service packages to offer optional additional benefits.

- Standardized Premium for Additional Benefits : Introducing a structured premium system for individuals seeking enhanced healthcare facilities. Ensuring compliance with Health Insurance Board standards.

- Operational and Structural Reforms : Reviewing and implementing basic health service packages, and clearing outstanding payments. The report also calls for modernizing the insurance system with automated digital solutions.

- Mandatory Insurance for Government and Formal Sector Employees : Requiring all government employees and organized sector workers to be automatically enrolled, with contributions deducted at the source.

- Progressive Premium Structure : Implementing a progressive premium model ranging from Rs 7,000 to Rs 15,000, while ensuring full subsidies for poor and marginalized groups.

- Legal Framework for Unified Healthcare Management : Enacting a comprehensive law to integrate health programs across all three levels of government for improved coordination and efficiency.

- 10-Year Plan for Universal Health Insurance : Implementing a 10-year roadmap to achieve 100% health insurance coverage.