The Constitution of Nepal, under Article 35, guarantees the right to health as a fundamental right. To ensure citizens’ basic health rights, the government launched the Health Insurance Program on 8 April, 2022. However, Ilam District Hospital has enforced a provision requiring patients to pay fees even for services covered under the health insurance program. As a result, complaints from service seekers have been increasing.
On 18 June, 2025,Tika Chapagain, 58, of Maijogmai Rural Municipality-3 reached Ilam District Hospital to get a blood test under the health insurance program. Although blood testing falls under the insured services, the hospital charged him a fee. He expressed that Ilam Hospital has been collecting fees from patients even for services covered by the government’s health insurance program, making no difference between insured and uninsured individuals.
The hospital has reportedly charged patients for tests that fall under the health insurance program. It has been found to issue bills and collect fees for dengue tests and blood culture, despite both services being included in the insurance coverage.
According to Arjun Pandit, Koshi Province Chief of the Health Insurance Board, dengue testing is supported by the provincial government and blood culture is also covered under the insurance scheme. He shared that, upon inquiry, the hospital stated the provincial support had ended. He described the act as a serious irregularity and said he had directed the Ilam Health Insurance Office to investigate the matter. He also mentioned that the hospital had been asked to clarify the reason behind charging fees for insured services. The hospitals must provide all tests and services covered under the health insurance program free of charge and can claim reimbursement through the insurance system. If any insured service or item has reached its allocated limit, the hospital should inform the public. However, Ilam Hospital failed to provide such information and continued charging patients, as reported by service recipients. nThey expressed dissatisfaction with the renewal process, which requires full payment without any concession despite the lack of service delivery.