Give A Boost To Health Insurance

Health insurance was launched in Nepal in 1976. Since then, the development of health insurance has been gradually taking place. In 2007, the government launched a free healthcare programme designed to provide all healthcare services up to the PHCC (primary health care centre) level and distribute 35 basic medicines free of cost. In 2013, the government introduced the Social Health Insurance Policy. In 2015, the government formed the Social Health Security Development Committee and the Social Health Insurance Programme was launched in 2016. The programme was integrated into the Health Insurance Board in 2017. The programme is now running as a priority initiative under the Health Insurance Act, 2017 in all the 77 districts. 

Nepal has launched various social security schemes for the benefit of its people. Among them, the Social Security Fund Scheme and the Elderly Allowance Scheme are prominent. The insurance-related programme, called the National Health Insurance Programme (NHIP), can be considered a social protection scheme.  As per the programme, households can take out medical insurance at an annual premium of Rs. 3,500 for up to five family members for an insured amount of Rs. 100,000. If the members of a household happen to exceed five, then an additional premium of Rs. 700 has to be paid for each family member added and the insured amount will increase at the rate of Rs. 20,000 per person, with the maximum insured amount not exceeding Rs. 200,000. 

Government funding 

The NHIP receives funding from the government and the insured people. The premium amounts received from the insured people are not sufficient to bear their medical costs. So the government provides funds for the programme. The government also provides subsidies on premiums for certain target groups. The National Health Insurance Board (NHIB) is responsible for managing the NHIP. The NHIP is a social protection programme that aims at enabling citizens to have access to quality healthcare facilities. Families, communities and the government are directly involved in this programme. So this programme may be considered a participatory approach to ensuring healthcare facilities for the people. 

The Constitution of Nepal has also the provision of free basic health services. In fact, the constitution treats access to healthcare facilities as one of the fundamental rights of the people. Article 51 (H) has a provision regarding safeguarding citizens’ right to have access to quality healthcare facilities. Likewise, the Sustainable Development Goals (SDGs) have, among others, the goal of health for all. One of the goals related to health is to achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all. Achieving the goal of universal health coverage is among the SDGs Nepal has to achieve by 2030, which is around five years away. 

At present, the cost of living in Nepal is rising. The price of everything is soaring. In a similar vein, medical costs are also rising. For the poor or underprivileged people, affording medical expenses is beyond their capacity. Accidents, life-threatening diseases like cancer, kidney failure and cirrhosis; chronic diseases like diabetes and hypertension; and other ailments entail heavy expenses. People may slip into poverty owing to high medical costs. Most people cannot bear high medical costs. They have to borrow at a usurious rate of interest. Medical costs increase their financial burden. Against this background, the NHIP has come as a blessing. Paying Rs. 3,500 a year is not a big deal when compared to the benefits provided by the programme. 

Under the NHIP, the health risks of people are managed within the framework of the government-provided social health protection. The programme aims at mitigating financial risks and burdens for insured individuals through health insurance. It also intends to improve the efficiency and accountability of healthcare providers or professionals so that every citizen gets access to quality healthcare facilities. 

The NHIP has covered over seven million people. Given the population of around 30 million, the number of those covered by the programme is low. It is imperative to extend the scope of the programme far and wide. For this, it is essential to enlist strong support from all stakeholders – government agencies, non-government agencies and development partners. They can help the NHIB in various ways. They can help the NHIB build capacity, manage claim processes, formulate evidence-based policy, update digital technology and engage in research to make the programme more effective.

Trust 

The number of households associated with the programme is gradually increasing. However, there are reports that hospitals that serve patients under the programme have not received claimed amounts for months. Hospitals like TU Teaching Hospital, Maharajgunj, Bir Hospital, Patan Hospital and Beni Hospial have reported non-receipt of claimed amounts from the NHIB. This has made it difficult for the hospitals to manage salary expenses, administrative expenses, medicine procurement and the like. Health insurance is one of the packages of the insurance business. People trust insurance companies when their claims get settled promptly. According to the NHIB, it takes time to process claims received from hospitals and other healthcare facilities. The processing of such claims needs to be expedited.

 Further, the government should manage funds on time so that the medical services under the programme are not disrupted. If claims are not settled on time, the hospitals concerned will no longer be able to provide treatment under the programme. This may give a negative message that the programme is not reliable and that it has been embarked upon without foresight. As such, the government should ensure that the medical services the people are getting under the programme are not disrupted. After all, it is a noble programme that may contribute to improving the healthcare sector.

(Maharjan has been regularly writing on contemporary issues for this daily since 2000.)