Treatment of Impoverished Citizens Through Health Insurance in Nepal
21st August 2025, Kathmandu
The Ministry of Health and Population has taken a monumental step towards creating a more equitable and efficient healthcare system by integrating several scattered social health security programs under a unified framework.
Health Insurance For Impoverished Citizens
This crucial reform, officially approved by Minister of Health and Population Pradeep Paudel, is detailed in the “Impoverished Citizens Medicine Treatment Program Operation Directive 2082 (First Amendment).” The primary goal of this directive is to ensure greater accessibility and transparency in healthcare delivery for Nepal’s poor and marginalized populations. It represents a fundamental shift towards a more systematic and streamlined approach to public health security, aiming to eliminate the complexities that previously hindered vulnerable citizens from receiving the care they need.
Key Features of the Unified System
The new directive is a cornerstone of the government’s strategy to improve healthcare governance and resource allocation. It was formulated in accordance with Section 41 of the Health Insurance Act, 2074, establishing a strong legal foundation for the program’s operations. The directive’s core principle is to simplify and organize the process of enrolling ultra-poor households into the national health insurance scheme.
The system relies on a targeted, systematic identification process. Households that have been officially designated as “Ultra Poor” by the Ministry of Land Management, Cooperatives, and Poverty Alleviation will now be automatically included in the national health insurance scheme. This automatic enrollment process is a significant change, as it removes the burden of a separate application process for the most vulnerable citizens. Once these families are provided with a Poverty Identity Card (Garib Parichayapatra), they will be treated as a single unit and brought under the comprehensive coverage of the program.
To access the benefits, the required documentation has been clearly defined, simplifying the process for beneficiaries. The documents necessary for enrollment include:
- The State Facility Identity Card, which serves as the official Poverty Identity Card.
- A Nepali Citizenship Certificate or National Identity Card for adults.
- A Minor Identity Card for children.
This documentation process will be facilitated at the local level by health insurance coordination committees and dedicated registration officers, ensuring that assistance is available to those who may face challenges navigating the system. This localized approach is designed to overcome geographical barriers and bring services closer to the communities that need them the most.
Comprehensive Benefits and Centralized Coverage
A key reform introduced by the directive is the centralization of payments for the treatment of eight critical diseases. Previously managed under a different system, these payments will now be handled directly by the Health Insurance Board under a unified, “one-door system.” This change is designed to enhance efficiency and accountability by creating a single point of financial management. It is now mandatory for citizens to be enrolled in the national health insurance scheme to receive these benefits. While the Health Insurance Board will oversee all financial transactions, other crucial administrative functions—such as the listing of eligible hospitals, integrated monitoring, and data entry and reporting—will remain under the purview of the Department of Health Services, Nursing, and Social Security Division.
The integration of the programs has led to a significant expansion and clarification of the benefits available to impoverished citizens. The coverage now includes:
Kidney Disease: The program provides free hemodialysis services for patients suffering from kidney disease. In the case of a kidney transplant, patients are eligible for a combined allowance of NPR 750,000, which includes benefits from both the health insurance and the impoverished citizen programs. Furthermore, to help with post-transplant care and living expenses, transplant patients will also receive a monthly subsistence allowance of NPR 5,000.
Eight Critical Diseases: The directive provides substantial financial support for the treatment of eight life-threatening conditions. The combined coverage for these diseases is up to NPR 300,000, which includes allowances from both the health insurance and impoverished citizen programs. The diseases covered under this provision are heart disease, cancer, Parkinson’s disease, Alzheimer’s disease, spinal injury, head injury, sickle cell anemia, and other severe conditions on the official list.
Heart Valve Surgery: The program ensures that patients under 15 years old or above 75 years old can receive free heart valve surgery at the Shahid Gangalal and Manmohan Cardiothoracic Centers. In addition to the free operation, an allowance of NPR 200,000 is provided through the health insurance program to cover other related costs.
Commitment to Good Governance
According to Minister Paudel, the primary motivation behind this reform is to instill better governance in healthcare financing. He emphasized that the government’s objective is to not only make health insurance services more accessible and affordable but also to consolidate previously fragmented healthcare facilities into a single, strong, and integrated social health security system. By doing so, the government can ensure a more efficient and transparent mobilization of state resources. The mandatory enrollment of the ultra-poor in the health insurance scheme is a crucial provision that discourages the misuse of state funds and guarantees that the benefits are directly channeled to those who genuinely need them. This integrated and transparent approach marks a significant milestone in Nepal’s efforts to build a more equitable, transparent, and accessible healthcare system, solidifying the state’s commitment to protecting its most vulnerable citizens.
