Health Ministry Initiates Protocol Reform to Eliminate Duplication in Insurance-Based Treatment
Kathmandu – The Ministry of Health and Population has initiated preparations to formulate a standardized health insurance treatment protocol aimed at eliminating duplication in basic health services. Health Minister Pradeep Poudel has formed a high-level expert committee through a ministerial decision to lead the process.
The move comes after concerns were raised regarding overlapping expenses within the government’s basic health service programs and the health insurance scheme. Although successive governments have provided free basic health services, patients have been found submitting claims under the health insurance scheme for services already covered, causing unnecessary financial burden on the state.
To address this issue, the newly formed expert committee has been tasked with developing a comprehensive protocol for diagnosis and treatment under the insurance program. The committee, chaired by former Director General of the Department of Health Services Dr. Rajendra Pant, is expected to submit its report within a month.
According to Dr. Saroj Sharma, Head of the Ministry’s Quality Measurement and Regulation Division, the protocol will establish technical standards to prevent duplication and streamline service delivery. The committee will also work on defining the scope of services at the initial point of care and propose a clear referral system for patients needing advanced care.
Additionally, the committee is mandated to review and recommend improvements to the service package offered through health insurance, ensuring that it complements, rather than overlaps with, the Government of Nepal’s free health care programs. This includes compiling a detailed implementation report of free health services at the local, provincial, and federal levels.
Ministry spokesperson Dr. Prakash Budhathoki stated that the reforms are expected to bring greater transparency and efficiency to Nepal’s healthcare delivery system. One key focus will be clarifying the integration of free medicines provided by the Ministry within the insurance framework.