Summary:
Tribhuvan University Teaching Hospital (TU Teaching Hospital) in Kathmandu has halted services under the government health insurance scheme starting January 15, 2026, due to a funding dispute. The hospital claims it has not received about Rs400 million in dues from the Health Insurance Board and only around 50% of claims are approved, causing monthly losses of Rs20 million. Patients covered by the insurance scheme have been denied services despite some hospital officials stating that services would continue until January 14.
The Health Insurance Board said it has already paid Rs14 billion to health facilities, including Rs11 billion from the Health Ministry and Rs3 billion collected from the public, but still owes Rs10.5 billion to 500 facilities due to a funding shortfall. Approximately 10 million people are covered by the insurance, with about 50,000 daily using services.
Common reasons for claim rejections include missing doctor registration numbers and improper prescriptions or diagnostics. The insurance scheme covers families of five for Rs3,500 annually, granting up to Rs100,000 coverage per year; additional members require extra premiums. The government pays premiums for vulnerable groups and covers about 55% of enrollees.
Negotiations between TU Teaching Hospital and the Health Insurance Board are ongoing to resolve the issue.
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