Bharatpur Hospital Health Insurance Model Sets National Benchmark
This image shows the building of Bharatpur Hospital in Chitwan district in December 2221. Photo courtesy: Bhupesh Dawadi
19th January 2026, Kathmandu
Bharatpur Hospital in Chitwan has emerged as Nepal’s most effective example of health insurance implementation, demonstrating how disciplined management, strict compliance with guidelines, and skilled human resources can significantly reduce claim rejections. At a time when major medical institutions are withdrawing from the national health insurance program due to financial losses, Bharatpur Hospital stands out as a model institution with a remarkably low rejection rate.
Bharatpur Hospital Health Insurance
The success of this government-run facility is particularly notable given the current landscape of healthcare in Nepal. On Magh 1, 2082, the Tribhuvan University Teaching Hospital (TUTH) announced its decision to discontinue health insurance services, citing a rejection rate of nearly 50 percent. In contrast, Bharatpur Hospital has maintained a claim rejection rate of only about 2.4 percent, despite handling a massive volume of patients and high total receivables.
Structured Insurance Management System
The primary factor behind the Bharatpur Hospital health insurance success lies in its dedicated and well-organized management structure. Unlike many hospitals that treat insurance as an administrative burden, Bharatpur has established a specialized health insurance unit. This unit operates 24 hours a day with 18 trained staff members working in rotating shifts to ensure that every patient interaction is documented correctly from the start.
All services and insurance claims are processed strictly within the framework of the Health Insurance Board’s (HIB) guidelines. By ensuring full documentation compliance before submission, the hospital minimizes errors that typically lead to financial loss. Because of this efficiency, Bharatpur Hospital has become a national learning center. Insurance officers and hospital administrators from across Nepal regularly visit the facility to study its processes, and several institutions even send their staff for hands-on training.
Verified Performance and Rejection Rates
According to Health Insurance Board Information Officer Bikesh Malla, the average claim rejection rate among hospitals in Nepal stands at around 20 percent. Rejections typically occur when hospitals fail to follow official procedures or bill for services not covered under the insurance provisions. Bharatpur Hospital’s performance significantly outperforms this national average.
Detailed data shared by the hospital’s Health Insurance Program Chief, Liladhar Paudel, illustrates this consistency over a three-month period in 2081/82:
Shrawan: 1.5 percent rejection
Bhadra: 2.8 percent rejection
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Ashoj: 3.3 percent rejection
The average rejection rate across these months is approximately 2.4 percent. Paudel noted that while staff spend significant time explaining insurance limitations to patients, this upfront effort prevents the hospital from incurring unsustainable expenses later.
Skilled Workforce and Technological Integration
Medical Superintendent Prof. Dr. Krishna Prasad Paudel credits the success to the mobilization of insurance-trained professionals and the strategic use of technology. The insurance department provides regular updates to doctors and healthcare workers regarding new board directives. This ensures that every medical professional within the hospital understands what can be claimed and how it must be recorded in the digital system.
Despite this operational success, the hospital still faces significant external challenges. Currently, over NPR 600 million in insurance reimbursements remains unpaid by the Health Insurance Board. Hospital officials emphasize that while they have fixed the internal rejection problem, the national system’s delay in payments continues to place financial pressure on the institution.
Financial Impact and National Context
Health insurance services have been operational at Bharatpur Hospital since Fiscal Year 2017/18. By the end of the last fiscal year, the hospital had delivered over 1.47 million insured services and received a total of NPR 2.47 billion in payments. This volume highlights the critical role the hospital plays in providing affordable healthcare to the residents of Chitwan and surrounding districts.
In the broader national landscape, the health insurance program is implemented in 510 hospitals across Nepal. While 10 million citizens are enrolled, only 6.8 million remain active beneficiaries. The Health Insurance Board reportedly owes hospitals nationwide a staggering NPR 10.5 billion. This debt is the primary reason many private and teaching hospitals are struggling to sustain their participation in the program.
Conclusion
The Bharatpur Hospital health insurance model serves as a practical and replicable blueprint for the rest of Nepal. It proves that efficient management, trained personnel, and transparent communication can dramatically improve financial outcomes for hospitals while providing essential services to the public. As the government seeks to strengthen the national health insurance system in 2026, the lessons learned in Bharatpur will be vital for ensuring the program’s long-term sustainability and the health of the Nepali people.
For More: Bharatpur Hospital Health Insurance
