Even as the government sets an ambitious plan to provide health
insurance coverage to all Nepalis, problems with identification of poor
households and inadequate inter-ministerial coordination are likely to impede a
nationwide coverage of the insurance scheme.
The lack of legal basis for identifying “too poor”,
“poor” and “the marginalised” has even affected spending of the money allocated
for insurance programmes.
According to Rule 11 of the Social Health Security
Programme (Operating) Regulations, 2015, the government will waive the premium
fees for persons with the identification cards issued by the Ministry of
Cooperatives and Poverty Alleviation.
The regulation states that it will waive
Rs2,500 in premium for people in abject poverty while 75 percent and 50
percent of the premium will be waived for the poor and the marginalised,
respectively. However, the ministry is yet to issue identity cards that
recognise the poor.
For the current fiscal year, the government has
earmarked Rs2.5 billion to expand the insurance programme to 25
districts.
“The present identification is entirely on
voluntary basis. Sometimes this would miss out the vulnerable population group
who need insurance the most,” said Dr Guna Raj Lohani, executive director of
the Social Health Security Development Committee (SHSDC).
The government on May 14 began the health insurance
programme from Kailali and expanded it to Baglung and Ilam districts later.
Under the current health insurance programme, a household of five has to pay an
annual premium of Rs2,500.
For additional household members, each of them
should pay Rs425. With this insurance scheme, the household can avail of health
services worth up to Rs50,000.
Officials said they are working to finalise the
poverty mapping done in 25 districts that categorises 356,418 households as
poor. “The Health Ministry has been asking us for the data. But we still need
two weeks to process it,” said Suresh Pradhan, joint-secretary at the
ministry.
The 25 districts surveyed include Baglung and
Kailali but not Ilam, meaning that the programme run in Ilam might not be
scientific unless the poor are identified.
Questioning the quality of the health services
available, Dr Ghanashyam Gautam, a health economist, said: “Without improving
the services delivered by the health institutions, people might hesitate to
join the insurance programme.”
Dr Gautam, who had played a crucial role
in designing the insurance programme, said since people are not used to
paying for future consequences, the government has to work hard in informing
the people.
The insurance covers healthcare bills of ensured
family members including the cost of medicine, doctor’s consultancy fees and
diagnostic services such as x-ray, ECG, ultrasound, endoscopy and
physiotherapy. For patients willing to use private hospital services, the SHSDC
is planning to sign an agreement with the operators.
‘Working to prepare legal ground’
Have you done preparations for universal health
insurance coverage or is this just an idea you are floating?
Health insurance has been discussed for quiet some
time now. We are working to finalise the Social Health Protection Bill that
mandates health insurance coverage for the whole population. The bill to be
tabled in Parliament within a month will provide a strong legal basis for
universal coverage of the insurance programme.
How would this be funded? How would the poor pay
for it?
The concept is the poor people will get the
government’s support for the premium while those who can afford will pay for
the services.
So the important thing here is identification of
the poor, for which another government agency is working. We have been asking
them to complete the work soon.
Do you have a working timeframe?
Besides the three districts in which the programme
is running, we plan to add 22 new ones this year.
It is the same facilities that provide health
services to the people who are insured. Given their sorry state, how can people
be encouraged to sign up for the programme?
I agree that our health facilities are not up
to the mark. But we need a point to begin the programme. If we wait for the
health facilities to be fully equipped for implementing insurance, it might
take ages. Alongside, we will be working to upgrade the health services.
Manish Gautam
Published:
07-12-2016
The Kathmandu post
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