Health Insurance: What Changes Have Been Made and What Are the Future Plans?
Image source, RSS
Health officials report that the government is implementing phased improvements to sustain the health insurance program currently active across the country.
Officials from the Ministry of Health and Food Safety and the Health Insurance Board have stated that some reforms have already been implemented and further steps are underway regarding the program.
Finance Minister Swarnim Wagle has pointed out that it is no longer feasible to continue the insurance program in its existing form, necessitating changes.
Experts have also suggested improving the current system of mobilizing financial resources to make Nepal’s health insurance program sustainable.
Although the government announced a budget of 2.1 billion rupees for the health insurance program this year, the Ministry of Finance has so far released only 1.1 billion rupees as of this Monday.
What Changes Have Been Made?
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According to the latest reforms implemented in the program, the Health Insurance Board has announced that insurance services, other than emergency treatment, have been suspended at private health institutions.
“Except for emergency services provided by private health institutions affiliated with the health insurance program, other insurance services have been suspended from May 30 due to financial challenges,” explained Shakuntala Prajapati, Executive Director of the board.
Additionally, Samirkumar Adhikari, spokesperson for the ministry, noted that the “benefits package” of the Health Insurance Board has also been revised and reapplied.
Under the new arrangement, instead of receiving fixed package payments, health institutions will be reimbursed based on the actual cost of the services and medicines provided.
Adhikari also said that earlier changes were made to the ‘first contact point’ system.
As a result of these changes, insured individuals must now visit the nearest or most convenient government health institution for initial treatment or check-ups.
What Future Changes Are Expected?
Development Secretary of the Ministry of Health and Food Safety, Bikash Devkota, highlighted the need for improvements in various aspects of the health insurance program.
Officials believe that efforts to reduce the financial burden on the frequently financially challenged insurance program will aid its sustainability.
Devkota pointed out that there is an issue of ‘duplication’ in expenditures for basic health services.
“By reducing this, we plan to provide only specialized services through the health insurance program,” he said.
Image source, RSS
He also noted that some policy preparations for improvements in the insurance program have already moved forward.
“We are working on revising the Insurance Act and integrating various government health insurance schemes into a unified model,” Devkota added.
“We are working on two fronts: integrating government health insurance systems while modifying basic health services, and amending the Insurance Act itself. We plan to draft and implement these changes during the months of August-September.”
Devkota also shared that some minor adjustments in insurance rates and new entitlements are being prepared, which will help deliver better services.
Towards a ‘Sustainable Model’
Finance Minister Wagle stated that the current health insurance model is not sustainable in the long term.
“This model is unsustainable and needs reform. Currently, there appears to be unnecessary misuse,” he said.
“Insurance should progress in a manner that provides subsidies or support specifically to vulnerable populations.”
He emphasized that services must be delivered proportionate to contributions for the middle class and others.
“An annual contribution of 3,500 rupees guaranteeing services worth 100,000 rupees is not a sustainable long-term model. This will be reformed. There will still be a health insurance program, but it will be sustainable and adaptable,” he explained.
“It is not feasible to carry unlimited financial obligations. Even if we spend 2.1 billion rupees, it might not be sufficient. The health insurance program will not consume the entire budget, so it must remain adaptable.”
Currently, the financial resources for health insurance come from two sources: the government and the insured citizens.
If the government contributes 3,500 rupees annually, treatment up to 100,000 rupees for communities of up to five members is provided free of charge.
According to the Insurance Board, while nearly 10 million citizens are enrolled in the program, only around 6 million are actively participating.
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