{"id":26061,"date":"2026-09-24T07:46:50","date_gmt":"2026-09-24T02:01:50","guid":{"rendered":"https:\/\/eng.dragonmedia.com.np\/?p=26061"},"modified":"2026-09-24T07:46:50","modified_gmt":"2026-09-24T02:01:50","slug":"health-insurance-must-earn-public-trust-through-treatment-not-cards","status":"publish","type":"post","link":"https:\/\/eng.dragonmedia.com.np\/?p=26061","title":{"rendered":"Health Insurance Must Earn Public Trust Through Treatment, Not Cards<\/strong>"},"content":{"rendered":"

Health insurance is an important social protection mechanism that shields citizens from the financial uncertainty of medical treatment. However, if insured patients must purchase medicines outside hospitals, wait excessively for essential diagnostic tests and pay part of their treatment costs out of pocket, the fundamental purpose of insurance is weakened. The success of health insurance should be measured not by membership figures or the number of cards distributed, but by whether patients receive the treatment they need when they need it.<\/p>\n

Although access to healthcare has expanded in Nepal, the actual cost of treatment remains a major concern for many families. A patient may find a doctor at a government hospital but discover that essential medicines are unavailable. Diagnostic equipment may be present, yet obtaining an appointment can be difficult. When hospitals cannot provide services covered by insurance, patients are forced to turn to private laboratories or pharmacies. Under such circumstances, benefits guaranteed on paper cannot provide citizens with the financial protection they expect.<\/p>\n

Financial management is also a serious issue in the operation of the health insurance programme. Delayed payments to hospitals for services already provided can affect medicine procurement, equipment operation and routine treatment. Conversely, releasing funds without properly examining claims creates risks of misuse of public resources. The Health Insurance Board must therefore make payments faster and more transparent, while hospitals must maintain reliable records of treatment and expenditure. Claiming financial discipline while patients remain deprived of services is equally inadequate.<\/p>\n

Medicine shortages are not limited to health insurance. When essential medicines that should be distributed free of charge at government health facilities fail to arrive on time, low-income families are particularly affected. For pregnant women, senior citizens, patients with chronic illnesses and people living in remote areas, interruptions in regular medication are not merely administrative shortcomings. They can directly affect treatment continuity and patients\u2019 health. This problem cannot be resolved without integrating procurement, storage, distribution and inventory information.<\/p>\n

The government should establish a system through which citizens can easily access information about available medicines, diagnostic services, the operational status of equipment and estimated waiting times at every government hospital and health facility. The practice of initiating procurement only after medicines run out must change. Timely decisions can be made using information on how much medicine remains at each facility and when additional supplies will be required. Clear arrangements are also needed regarding where patients should be referred when a hospital cannot provide a service and how the associated costs will be managed.<\/p>\n

Making health insurance sustainable requires a realistic balance among contributions, government subsidies, service charges and treatment claims. However, financial difficulties must not be addressed by leaving patients in uncertainty. Citizens should receive clear information about the programme\u2019s capacity and available services. Treatment for low-income families and vulnerable groups must be ensured while unnecessary expenditure is controlled, claims are regularly examined and hospital performance is improved. Patients must not bear the ultimate burden of disputes between healthcare providers and the Health Insurance Board.<\/p>\n

Nepal\u2019s Constitution guarantees citizens the right to basic healthcare. Translating that right into practice is a shared responsibility of the federal, provincial and local governments. Ambiguity in the division of responsibilities must no longer allow one institution to blame another for weaknesses in medicine procurement, workforce management and service delivery. Citizens seeking treatment should not have to determine which level of government is responsible. The relevant authorities must coordinate to ensure that services are available.<\/p>\n

Restoring public confidence in health insurance requires reliable services, not additional publicity. Patients arriving at hospitals should be able to consult doctors, undergo necessary tests on time, obtain prescribed medicines and receive clear information about treatment costs. As long as insured citizens must seek loans to pay for treatment despite carrying health insurance cards, the purpose of social protection will remain unfulfilled. The government\u2019s priority must now shift from announcing the expansion of insurance coverage to ensuring that insured citizens actually receive treatment.<\/p>\n

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