The National Health Policy of Nepal aims to encourage private healthcare systems alongside public health institutions. With the objective of public–private partnership, it supports the expansion of both public and private health institutions throughout the nation. According to the World Health Organization (WHO), government hospitals in Nepal do not meet satisfactory standards. The ratio of hospital beds and medical professionals to the population is inadequate. The prevalence of disease is significantly higher in Nepal compared to other South Asian countries. A large section of the population, particularly those living in rural and remote areas, is at risk of infection and mortality from communicable diseases, malnutrition, and other health-related issues due to limited access to health facilities.
Sound health is the greatest wealth, and a healthy body provides the strength and energy needed to achieve better accomplishments in every aspect of life. Is healthcare a right or a luxury? Is it solely the responsibility of the government, or should the private sector also be encouraged? It is universally true that no government can afford to provide high-quality health services to all its citizens alone, and the contribution and involvement of the private sector therefore seem unavoidable.
People have expiry dates, and with increasing life expectancy, they require more healthcare attention in old age. Due to the rapid expansion of quality private hospitals compared to government hospitals, there is growing public attraction toward private healthcare institutions. As private hospitals are opened with business motives, there is a public perception that they are becoming increasingly expensive and less affordable for poor people, and that they mainly serve those who can pay high hospital bills.
An urgent plea to protect healthcare providers
The commercialization of healthcare can be compared to the hotel industry. A hotel does not accept guests who cannot afford the cost of its rooms. This may be natural in hotel business and other commercial endeavors, but healthcare concerns matters of life and death. Commercialization in healthcare is a double-edged sword, bringing potential advantages such as innovation and efficiency, as well as disadvantages such as profit prioritization over care, increased inequality, and erosion of trust. The growing profit-driven motive in private healthcare often conflicts with the humanitarian goal of providing care to poor communities by making essential treatments unaffordable.
The health sector in Nepal still has a long way to go to develop affordable healthcare with assured quality for all. There are significant gaps between urban and rural municipalities in terms of health facilities. Specialized hospitals, both public and private, are concentrated in major cities, while rural areas have very limited access. Despite the increasing number of specialized private hospitals, the number of large and specialized government hospitals has not increased. Specialized government hospitals in major cities, particularly in the Kathmandu Valley, are struggling to cope with the growing valley population as well as the large inflow of patients from other districts seeking treatment.
With the rapid increase in numbers, private health institutions mostly focus on business, as they often lack a strong commitment to providing affordable services to poor communities. However, they receive tax reductions and government facilities to import ambulances, instruments, and equipment. Many private hospitals also hesitate to fully implement the provision of 10 percent free and mandatory treatment for poor, helpless, unidentified, and emergency patients who cannot afford hospital bills.
One of the major problems in the health sector, not only in Nepal but also in most developing countries, is the payment of hospital bills by the general public. In developed countries, health insurance systems are comparatively more effective and well developed, reducing financial worries for patients. Even unemployed and low-income individuals receive government support for insurance premiums. This approach has addressed major financial concerns for both patients and hospitals. However, Nepal’s health insurance system faces serious challenges due to resource constraints and management difficulties. Due to budget limitations and delays in reimbursement, several hospitals have halted health insurance services.
To make the health insurance system more effective in Nepal, the government and private sector, including all employers, must be compulsorily integrated into the system. The government should pay insurance premiums for people living below the poverty line, while local governments should share responsibility for management and cost-sharing. Expanding a strong insurance system across both public and private hospitals would significantly reduce the burden of out-of-pocket payments, which are often financially devastating for patients. Both public and private health services must also be expanded in rural areas through effective government policies. There has been no significant increase in the number of health personnel in government hospitals for decades. Due to low salaries and unsupportive working environments, thousands of doctors and health professionals are migrating abroad for better opportunities. Salaries and benefits for medical professionals must be higher than those of other civil servants to curb brain drain.
Provincial and local governments must be financially capable of assuming responsibility for health institutions in their respective areas. There is also an urgent need to expand and strengthen specialized public hospitals in the Kathmandu Valley and other major metropolitan areas. In addition, the government should actively encourage and facilitate both public and private sectors to establish medicine manufacturing plants and medical equipment industries within the country to promote self-reliance. Similarly, Ayurveda and traditional healthcare services, which are comparatively affordable in Nepal, should receive greater priority and institutional support from the government.
Everything in the health sector is not as negative as it may appear. Several non-profit organizations and medical colleges with sound financial bases provide affordable healthcare services to the general public. Free primary healthcare services, subsidies, and free treatment for chronic and complex diseases in public hospitals are positive aspects of Nepal’s health system. Nepal’s eye care services are among the most affordable and effective in South Asia, attracting a large number of patients from neighboring regions of India.
The government must strike a proper balance between essential healthcare services as a fundamental right and the market-oriented healthcare system. While commercialization may be beneficial for business and productive sectors, healthcare requires cautious implementation to preserve both innovation and service ethics. The government must take a leading role by providing adequate resources to public health institutions and effectively regulating private hospitals to ensure quality services. Given the low budget allocation to the health sector, the government must increase funding to improve infrastructure, adopt new technologies, and create a supportive environment for poor populations within private healthcare institutions as well.
