Nepal has long sought to expand access to essential health services and cut related financial burden on the poor and the middle class, with the ambitious goal of achieving universal health coverage by 2030. To this end, in 2017, the country introduced the National Health Insurance Programme (NHIP) under the Health Insurance Act. However, this ambition of universal coverage seems increasingly elusive given the persistent issues plaguing the NHIP, including structural weaknesses, weak governance and, most crucially, underfunding. The insurance programme has become so unpopular that the renewal rate has declined to around 50 percent.

The NHIP-targeted decisions over the past few months have only worsened its sorry state. In January, the government slashed the outpatient department (OPD) ceiling for families from Rs100,000 to Rs25,000. And recently, citing a financial burden on the Health Insurance Board, the board starting this month halted outpatient services under the insurance scheme at private hospitals. As a result, state-run Bir Hospital and Tribhuvan University Teaching Hospital (TUTH) are seeing a massive increase in the number of patients, overcrowding OPD services, and further delaying essential services.

Now, patients, despite paying the insurance premium, are forced to top up with exorbitant fees at private hospitals. But, for their part, as the government has yet to pay them their insurance coverage fees, state-run hospitals have also not been providing full services under the insurance scheme. These hospitals also lack most medicines covered by insurance, forcing patients to go to expensive pharmacies. In this state, it wouldn’t be an exaggeration to say that Nepal has failed its citizens by selling a health scheme that no longer insures them.

Reportedly, private hospitals account for a disproportionate share of claims compared to governmental facilities, and rising liabilities have left the Health Insurance Board financially constrained. Yet a financial crisis, however serious, cannot justify abandoning commitments already made to citizens—and that, too, in a matter as serious as health. Insurance is fundamentally a contract of trust. People pay premiums expecting to get affordable and hassle-free services in return. When the government fails to do so, it breaks that trust. The solution is stronger oversight of hospitals, not denying patients access to health facilities. Still, officials at the Health Insurance Board are not worried about the declining renewal rate, as they believe it reduces the board’s burden. Such a mindset raises a crucial question: how can the country achieve the goal of universal health coverage when the very scheme introduced for the purpose lacks public trust?

Universal coverage should ensure that every Nepali has access to essential health services, regardless of their financial status, rather than falling further behind with every policy reversal. For the fiscal year 2026-27, the government has set aside Rs15 billion for the Health Insurance Programme. The new government has the means to revive the NHIP, which is already on the verge of collapse. It is upon this strong government to prove that under it, health is a right, not a luxury in Nepal. The scheme was designed with the right purpose, and it shouldn’t be left in limbo, as many people living below the poverty line, elderly people, family members of people with HIV and differently-abled people, among others, still pin high hopes on it. A democratic state cannot fail its most vulnerable members.