Hospitals pulling out of health insurance program

By Mahima Devkota, Kathmandu, June 25: Hospitals have started pulling out of the government-run health insurance program in lack of meeting the interests of hospitals.

Issuing a notice on Friday, TU. Teaching Hospital (TUTH) announced to discontinue the insurance services from June 29 reasoning that the Health Insurance Board (HIB) failed to reimburse the necessary amount in exchange for the provided services timely. TUTH is associated with the health insurance program from the year 2020.

HIB has provided around Rs 69.1 million to the TUTH since it got registered with the scheme two years ago, however, Dr Dinesh Kafle, Executive Director at TUTH said that it was not the total amount that they have claimed.

Similarly, on Wednesday B and C hospital in Jhapa and Nobel Medical College in Biratnagar held a press conference and announced to close the health insurance program from July 4.

The main reason behind the announcement of the closure of the health insurance program by the hospitals is that they have not received the money for the medical services of the insured for a long time.

Health insurance is run by the government on the concept of universal access to health to denizens, especially to people from humble backgrounds, aged, women, children, and differently able people.

As per the new declaration, private insurance will no longer be associated with government-run run health insurance programs from August, 5.

According to Dr Damodar Basula, Executive Director at HIB, Board is collecting the premium of around Rs 3.5 billion annually but has to reimburse more than thrice, around Rs 11 billion the collected amount of the health centres providing the services.

A total of 5.7 million people are enrolled in the scheme and 75 per cent of individuals renewed last year, while it is speculated that 70 per cent of the insurer will renew this fiscal year.

According to the Health Insurance Board, the remaining 1,909,057 from the previous fiscal year claimed health insurance in the fiscal year 2078/79. Likewise, 3,375,837 claimed health insurance in the current fiscal year making a total of 5,284,894 claims.