Insurance Crisis Deepens at Bir Hospital as Patient Load Surges, Drug Supply Cut and Treatment Delays Stretch for Months

KATHMANDU: Nepal’s public health insurance system is facing mounting strain at Bir Hospital, where a surge in insured patients, medicine shortages, and long diagnostic queues have exposed serious structural weaknesses in the country’s flagship public healthcare network.

Patients arriving for treatment now report waiting hours just to obtain outpatient tickets, while diagnostic procedures such as MRI scans can take months to schedule. The hospital has also reduced the quantity of medicines distributed under insurance coverage, cutting supply from three months to one due to stock shortages.

The crisis intensified after Tribhuvan University Teaching Hospital halted its health insurance services earlier this month, citing unpaid dues from the state. The decision diverted large numbers of insured patients to Bir Hospital, dramatically increasing the pressure on its already stretched facilities.

Patients travelling days, waiting hours

Lokjan Rawat from Bajura reached the hospital at 8 a.m. only to receive ticket number 700. After two hours in line, he finally secured an OPD ticket but still had not met a doctor by 11 a.m.

He had first gone to the Teaching Hospital, unaware that insurance services had been suspended there.

He said he came to Bir solely because treatment costs are lower and insurance coverage is available. But the crowd and uncertainty now make him question whether coming to the public hospital was the right decision.

Another patient, Sukaram Tamang from Sindhuli, arrived with his wife suffering from neurological problems. After two years of treatment at the Teaching Hospital, he was forced to shift to Bir following the insurance suspension there. Even reaching the OPD room proved difficult amid the crowd.

Patients say queues dominate every stage of care — from ticket counters to consultations to diagnostics.

Patient load rising sharply

Hospital officials confirm that the number of insured patients has risen significantly since the Teaching Hospital stopped services.

According to Bir Hospital data, before Magh the hospital treated roughly 10,000 to 13,000 insured patients per month. Since then, the numbers have climbed.

• Mangsir: 14,475 insured patients
• Poush: 15,846
• Magh: 15,804

The increase began immediately after the Teaching Hospital issued notice that it would suspend insurance services. Since then, monthly patient numbers have risen by roughly a thousand.

Doctors say Bir has always served as a national referral hub, but the insurance disruption elsewhere has accelerated the flow.

Neurologist Dr. Avinash Chandra said many patients now arrive already insured, and rumours that other hospitals may also halt insurance services are further driving crowds toward Bir.

Treatment queues stretching months

With the growing patient load, waiting times for diagnostic services have lengthened dramatically.

Sobi Thapa from Achham travelled to Kathmandu after treatment attempts in India and Dhangadhi failed to resolve her chronic limb pain. At Bir, doctors recommended a cervical spine MRI.

She was told the earliest available appointment could be in Baisakh — months away.

Unable to wait, she ultimately paid Rs 20,000 at a private clinic to complete the scan.

Patients say such delays effectively undermine the purpose of the insurance system, as those unable to afford private care face prolonged suffering or risk worsening health conditions.

Medicine supply cut to one month

The hospital has also reduced medicine distribution under insurance coverage from three months’ supply to one month starting Falgun 1.

Officials say the decision was necessary to manage shortages and ensure more patients can receive at least minimal treatment.

Hospital Information Officer Hari Pangenni said the move is intended to keep the service running rather than suspend it altogether.

He added that Bir is owed roughly Rs 500 million in unpaid insurance reimbursements, which has made it difficult to maintain drug procurement and supplier payments. Vendors continue delivering medicines despite delayed payments, but the situation is becoming increasingly unsustainable.

Systemic pressure on Nepal’s health insurance model

The developments highlight deeper structural problems in Nepal’s public health insurance programme — delayed reimbursements, uneven hospital participation, and growing dependence on a handful of major public hospitals.

As more institutions struggle with unpaid claims, experts warn that similar service suspensions could spread, further concentrating patient loads at a few hospitals and worsening treatment delays nationwide.

For now, Bir Hospital remains one of the last major centres maintaining insurance coverage, but the strain visible in its crowded corridors suggests the system may be approaching a breaking point.