The Rapti Academy of Health Sciences (RAHS), Ghorahi, is having difficulties in delivering services and managing other expenses due to non-payment from the Health Insurance Board for a long time.

According to RAHS, the board has not reimbursed more than Rs135 million for the treatment of insured patients, including costs for medication, lab tests, and surgeries, among other things.

Dr Bikash Lamichhane, vice chancellor of RAHS, said that due to lack of funds, the institution is grappling with difficulties in purchasing medicines and other necessary materials. He also said that discussions are going on with the executive council of the academy to stop providing treatment to those covered by health insurance.

“The financial crisis has become a huge burden for us,” Lamichhane said, adding, “The situation arose because of the prolonged delay by the board in clearing the treatment bills. We don’t even have enough funds to buy essential medical supplies, so we have decided to call an all-party meeting to stop treatments covered by health insurance,” said Lamichhane.

According to Lamichhane, around 700 patients visit the hospital every day, with around 30 percent covered by insurance. Similarly, the hospital offers a range of services to insured patients, including routine and follow-up checkups, medicines, lab tests, dialysis, surgeries, and access to the Intensive Care Unit (ICU).

Lamichhane said that the academy has not been able to pay its suppliers for the medicine and health materials for a long time, and the suppliers have warned and sent a notice to RAHS stating that they would soon stop supplies.

“But the Health Insurance Board has not shown any interest in settling our dues, even though we wrote to them on February 26 about the challenges in delivering healthcare services and the warnings issued by the medicine suppliers. We don’t know how we will be able to continue providing services in the ICU and the dialysis department if the supplies are stopped,” said Lamichhane.

On February 25, both the Chemical and Medical Suppliers Association, Dang, and the Pharmaceutical Professional Association, Dang, sent notices to RAHS demanding payment for outstanding dues owed to all medical suppliers.

Balkumar Gharti, chairman of the Chemical and Medical Suppliers Association, Dang, said that several business organisations affiliated with the association, supplying essential healthcare materials including medicines, lab chemicals, and X-ray essentials among other things have not received payments for a long time.

“Despite issuing a warning notice indicating our inability to continue supplying healthcare materials if payments are not made promptly, the academy has remained non-responsive. Some small-scale businessmen are extremely frustrated and are contemplating legal action as their businesses are on the verge of closure. But we have persuaded them to continue the supply,” said Gharti.

Gharti also emphasised that the suppliers cannot sustain the situation for much longer and said they may halt supplies if the payments are not settled promptly.

According to RAHS, they are considering discontinuing the insurance programme because the insurance board has not paid Rs30.7 million from the last fiscal year and Rs105 million from the current fiscal year.

Dr Damodar Basaula, executive director of the Health Insurance Board, said that the board’s operations have been hindered by political and legal issues.

Basaula was reinstated by the court after being removed twice from his post by the government. The then Health Minister Mohan Bahadur Basnet had suspended Basaula for three months on October 13, 2023, and later, on December 22, 2023, the Supreme Court issued an interim verdict on December 22, 2023, staying the implementation of the minister’s decision.

After Basaula returned to work, he was again sacked from his post by the Council of Ministers on January 23. The Council of Ministers cited his inability to expedite the work of the insurance board and resolve even minor problems as grounds for his removal. Later, he was reinstated by another order from the Supreme Court.

"Due to such repeated incidents on the board, its operations have struggled to gain momentum,” said Basaula.

Om Kumari Kandel, the information officer of the insurance board, admitted the delay in disbursing the health insurance amount and said that preparations are being made to make the payments soon.

“After the RAHS informed us about its problem, we requested not to discontinue the insurance programme, because the health and well-being of many poor and underprivileged people depend on it. Due to a delay in billing and evaluating the documents, there has been a delay in sending the funds,” said Kandel.

Contrary to the RAHS officials’ claims, Kandel asserted that the payments from August 18 onwards are the only pending, and there are no outstanding payments from the last fiscal year.

“Even though the RAHS claims they have not been fully paid by the board since last fiscal year, that is not true. All payments have been made. However, some documents were rejected on the grounds that they did not align with our policy, and some were rejected for lack of essential document attachments,” said Kandel.

She further added that if the RAHS wants to receive the claimed amount, they must first submit the necessary documents of the patients and their treatment.