0 Comments The Government of Nepal’s Health Insurance Board has announced a major policy shift, deciding to delist all private and community health institutions as “first service points” for the national health insurance program. The change is set to take effect from Shrawan 1, 2081 (approximately mid-July 2024).
This new directive means that individuals enrolled in the national health insurance scheme will be required to seek their initial medical consultations and referrals exclusively from government-run health facilities.
The decision was formalized in an official letter, dated Jestha 10, 2081 (May 23, 2024), and circulated to all private and community hospitals currently serving as first service points. The notice, signed by Section Officer Jhalakraj Joshi, states that the move is in accordance with the Health Insurance Act, 2074 (Second Amendment) and the Health Insurance Regulations, 2075 (First Amendment).
Under the existing system, insured citizens could choose a designated government, private, or community hospital as their primary point of care. This “first service point” is where patients must go for initial diagnosis, treatment, and, if needed, a referral to a secondary or tertiary hospital.
The letter from the Health Insurance Board acknowledged the role these institutions have played. “The Health Insurance Board extends its gratitude for the contributions made in delivering services as a first service point until now,” it stated.
This policy change marks a significant overhaul of how Nepalis access care through the national insurance program. It will eliminate the flexibility for patients to use private or community health centers for their initial insured services, a move that is expected to increase the patient load on government hospitals across the country.
The directive has been forwarded to all provincial and district offices of the Health Insurance Board for implementation.
