Health Insurance Board implements 10% co-payment system to limit random tests

By A Staff Reporter,Kathmandu, Jan. 17: In a recent development, the Health Insurance Board has introduced a co-payment system requiring insured individuals to contribute 10 per cent of their treatment costs. Dr. Damodar Basaula, Executive Director of the Health Insurance Board, stated that this new measure, effective from January 15, aims to address the issue of insured patients pressing doctors for unnecessary 'whole body' health examinations.

The motivation behind the 10 per cent co-payment, as explained by Basaula, is to discourage unnecessary medical tests prompted by insured individuals who feel their entitled benefits are underutilised by the hospitals. 

In response to concerns about certain private hospitals conducting random tests on patients with health insurance coverage, the co-payment system places 10 per cent of the financial responsibility on the insured individual.

Dr. Gunraj Lohani, Chairperson of the Health Insurance Board, expressed optimism about the positive impact of the co-payment system. He believes that the implementation of this system will deter insured individuals from insisting on unwarranted tests by citing pending insurance fees, thereby leading to an overall improvement in health insurance practices.

The 10 per cent co-payment system will be applicable across various services provided by designated hospitals, encompassing external and internal medical procedures, diagnostic tests, therapeutic interventions, surgeries, physiotherapy, rehabilitation, and more. Notably, this provision excludes programmes offered free of charge by the Nepal government, such as maternal protection, childhood disease management, tuberculosis and leprosy treatments, and various public health services.

Dr. Lohani clarified that the co-payment system would  not be enforced in primary health centres, government hospitals with up to 25 beds, and specific government-run programmes. Furthermore, the revised cost of the Outpatient Department (OPD) package has been announced, reducing fees for insured individuals from Rs. 200  to Rs. 50, and emergency fees from Rs. 400 to Rs. 100.