Kathmandu— The Health Insurance Board has released its annual report, sharing key insights from the fiscal year 2080/81. According to the report, 8.29 million individuals were enrolled under the national health insurance scheme. However, the number of insurance claims filed reached 9.7 million, surpassing the number of insured individuals.

Out of the 9.7 million claims, less than 50% have been processed and settled. A total of 4.57 million claims were verified and fully assessed. Based on the population, 28% of Nepalese are currently covered by the health insurance program.

Higher Average Claims from Private Hospitals

The report compares claim data by hospital type, showing that private hospitals had an average claim amount nearly three times higher than public hospitals. The average claim per patient at private hospitals stood at NPR 4,465, while it was only NPR 1,685 at government hospitals.

Highest Claim Rates in Bagmati and Koshi Provinces

Among provinces, Bagmati and Koshi reported the highest claim percentages. In Bagmati, 32.5% of insured individuals made claims, followed closely by Koshi at 32%. In contrast, provinces like Sudurpaschim, Karnali, and Madhesh saw fewer than 4 out of every 100 insured individuals utilizing their insurance benefits.

Most Claimed Diseases: Hypertension and Diabetes

Hypertension and type 2 diabetes were the most frequently claimed health conditions. Hypertension accounted for 8.1% of the total claims, while type 2 diabetes made up 7%.