KATHMANDU: Data from the Health Insurance Board indicates that only 60 percent of enrolled citizens are actively utilizing health insurance services in Nepal. Out of the 10.74 million people registered under the scheme, only 6.53 million are currently active.

Statistics show that among 3.86 million enrolled families, only 2.41 million remain active, suggesting a significant portion of beneficiaries are not renewing their coverage.

Health Insurance Board spokesperson Dr. Pawan Kumar Shah stated that the number of insured individuals has not declined significantly. He attributed the current figures to a three-month renewal cycle and the automatic renewal process for targeted groups, noting that there are 1.5 million people in the targeted category alone.

Former board director Dr. Senendra Raj Upreti highlighted that declining service quality and accessibility have reduced public interest. He pointed to issues such as the discontinuation of services at private hospitals, delays in claim payments, and the lack of a biometric system to verify patients. “Patients face overcrowding at hospitals, and there are complaints that those using insurance are treated as second-class citizens,” Upreti said. He added that the unavailability of essential medicines at hospitals further discourages participation.

Public health expert Dr. Sharad Onta identified structural flaws, noting that the government has failed to make insurance mandatory or implement a progressive premium system. He argued that because basic health services are not yet free and high-quality, citizens are forced to rely on a strained insurance system. Onta emphasized that the lack of a robust insurance fund makes timely payments to service providers difficult. He suggested that premiums should be adjusted based on income capacity to ensure the fund remains sustainable without relying solely on the state treasury.