The Health Insurance Board has designated Koshi Hospital as a “referral center,” prompting strong objections from the hospital administration. In response, the hospital has formally requested the Board and the Ministry of Health and Population to reconsider the decision.
In a letter, Medical Superintendent Dr Runa Jha warned, “If Koshi Hospital is removed as a ‘first service point’ and designated only as a ‘referral center,’ the patient load will decrease by nearly two-thirds. This will directly impact the hospital’s operations, income, and services.”
According to the Board’s decision, Koshi Hospital will no longer serve as a first point of contact for patients under the national health insurance scheme. Previously, it functioned as both a first service point and a referral center. The hospital argues that this change will restrict public access to government health services and weaken public hospitals to the benefit of private institutions.
Dr Jha added, “If referral centers had been designated exclusively for government hospitals, there would be no objection. Koshi Hospital is not like Bir Hospital or the Teaching Hospital—sometimes we ourselves must refer patients elsewhere. We are not equipped to compete with private hospitals in terms of referrals, and doing so could damage our reputation, services, and financial sustainability.”
Currently, the Rani Primary Health Center is the only designated first service point within Biratnagar Metropolitan City. However, the hospital claims this center lacks the infrastructure to accommodate the hundreds of patients that Koshi Hospital treats daily. Around 70 percent of its patients are under the health insurance scheme, and 40 percent of those specifically choose Koshi Hospital as their first point of care.
The hospital argues that the new arrangement will force patients to seek referrals from other municipal-level hospitals, disproportionately affecting the poor. “Many uninsured patients, who are mostly from low-income backgrounds, relied on Koshi Hospital for free services. Their access will now be limited,” the letter notes. A decline in internal revenue could lead to challenges in paying salaries, declining service quality, and disruptions in human resource operations.
Morang Constituency-4 MP Aman Lal Modi also strongly criticized the Health Insurance Board’s decision. “This move seems aimed at boosting private hospital profits by weakening public hospitals. They are ruining services by restricting referrals to Koshi Hospital and the BP Koirala Institute of Health Sciences in Dharan,” he said.
MP Modi added that many municipalities will struggle to provide timely referrals, pushing patients toward private institutions and limiting access to affordable care. He called on the government to reverse the decision and reinstate Koshi Hospital as a first service point. He also alleged growing influence of brokers and middlemen in the health insurance system, suggesting that the current decision was influenced by their pressure. Such actions, he warned, could erode public trust in the insurance system itself.
Koshi Hospital, the largest government health institution in Koshi Province, serves over 1,000 patients daily. The administration has stated that maintaining both roles—first service point and referral center—is essential for the effective implementation of the health insurance scheme. They cautioned that undermining the hospital through policy changes would have a long-term, province-wide impact on public healthcare. The hospital has urged the Health Insurance Board to reconsider its decision.
