Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Centre have resumed services under the government health insurance scheme, which had been suspended since January, bringing relief to thousands of ailing people from across the country.

Every day, hundreds of poor and ailing people from across the country used to visit these two hospitals before services were suspended over long-pending dues.

“We have been informed that Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Centre have resumed indoor services under the government health insurance scheme,” said Bikesh Malla, an information officer at the Health Insurance Board. “A lot of patients had been affected by the halt in health insurance services at these two hospitals.”

The hospitals had stopped providing services under the government health insurance scheme from January 15 after the government failed to reimburse long-pending dues. Due to the abrupt halt in services under the scheme, patients seeking care at these facilities were forced to pay out of pocket, seek care at other hospitals, or return home without treatment.

The hospital administration had also complained that the board approved only 50 percent of the insurance claims submitted by the hospitals and had demanded a revision in service prices.

“We have revised the price of services and paid all outstanding dues until January this year,” said Malla. “Outpatient services resumed a few weeks ago, and now the administrations of these two hospitals have agreed to resume indoor services as well.”

Officials at several other hospitals outside the Valley have also resumed services under the health insurance scheme. Some hospitals, including Shahid Gangalal National Heart Centre, have resumed only outpatient care. Those hospitals said that providing services under the existing rates set by the Health Insurance Board was not sustainable.

“We cannot run and sustain our hospital if we provide services at the rates set by the Health Insurance Board,” said Dr Rabindra Bhakta Timala, acting executive director of the hospital. “We have to run our hospital on our own, and we will incur losses if we provide services at the prices offered by the government.”

The suspension of services under the government's health insurance scheme drew widespread criticism, with concerns raised by various quarters, including in Parliament. Public health experts had questioned the government's commitment to the constitutional provision guaranteeing free basic healthcare for all.

Officials said the board has reimbursed Rs25 billion in hospital dues accumulated until January this year. The government had allocated Rs10 billion in the last fiscal year’s budget and provided an additional Rs15 billion to resume halted services under the health insurance scheme.

Earlier, the board had lowered the ceiling for outpatient services to Rs25,000 for patients and their family members from Rs100,000 in January. In May, the board halted outpatient care at private hospitals under the government health insurance scheme, citing a growing financial burden.

Even state-run hospitals, including Bir Hospital, which have been operating with government grants, have been providing only partial services to patients under the health insurance scheme. Some patients have been denied health services, including surgical procedures, at major hospitals, while others have been forced to pay out of pocket.

Officials at the board said they have not yet changed the policy to resume inpatient services at private hospitals or increase the outpatient care ceiling.

The health insurance scheme is the government’s priority programme aimed at ensuring universal health coverage. Under the scheme, a family of up to five members pays Rs3,500 for treatment, including medicines, check-ups, and counselling. One family member can use insurance coverage worth Rs100,000 per year, or the amount can be divided among five members. Families with more than five members pay Rs700 per additional member for additional coverage of Rs20,000.

People covered by the insurance scheme can access healthcare services at designated facilities by presenting their identity cards. Expenses incurred by health facilities are reimbursed by the Health Insurance Board.

For patients with chronic diseases, the government provides Rs200,000 in insurance coverage. As of the last fiscal year, the board has paid over Rs50 million under this provision, officials said.

The government also covers premiums for certain groups—people living below the poverty line in 26 districts, those above 70 years of age, family members of people living with HIV, people with disabilities, and those suffering from leprosy and multidrug-resistant tuberculosis.

Currently, the government pays insurance premiums for around 55 percent of people enrolled in the scheme.