Free Hospital Beds for the Needy: How Effective Is the Policy and Why Are Private Hospitals Hesitant?
Image source, BBC/MADHURI MAHATO
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The Ministry of Health has recently intensified efforts to enforce the provision requiring hospitals to allocate 10% of their beds for free treatment to the economically disadvantaged.
However, several public health experts have observed that this policy has been ineffective since its inception and stress the need for comprehensive improvements to make it truly effective.
Although this mandate was included in the Health Institution Operation Guidelines, 2077 (Nepali calendar), its implementation has faced significant challenges. The regulation stipulates that “10% of total hospital beds must be reserved and made available free of charge for indigent, helpless, and abandoned patients seeking treatment.”
“The government’s move to tighten enforcement despite previously poor implementation is a positive step,” said former senior public health administrator Chudamani Bhandari.
“However, unless we address the weaknesses in the policy, its monitoring, and transparency issues, the expected outcomes cannot be achieved.”
The government, led by Prime Minister Balendra Shah Balen, continues to push for strict enforcement of the 10% free bed provision.
This issue is also prioritized in the government’s comprehensive governance reform agenda, which states: “Government and private hospitals must immediately enforce a minimum 10% free bed allocation strictly.”
Prime Minister Shah mentioned the provision during his announcement to rescind the ‘equity tax’ imposed on health and education sectors.
What Private Hospitals Say
Image source, Getty Images
According to officials from the Ministry of Health, private hospitals have shown more challenges in implementing this arrangement compared to government or community hospitals.
“They have been reluctant to comply,” said Dr. Navaraj Joshi, appointed as the focal person for effective implementation, just on Thursday.
Nevertheless, private hospital operators refute these accusations.
“We are providing services and will continue to do so,” said Hemraj Dahal, General Secretary of the umbrella organization of private hospitals, AFIN-Nepal. “However, there are numerous policy and technical questions regarding this.”
“When naming beneficiaries as ‘needy’, people with influence exploit the system. There is a problem with how these recommendations for ‘needy’ are issued—it lacks clarity and so does the allocation of which beds are designated for this purpose.”
The Ministry of Health’s procedure targets “patients recommended by local authorities as economically disadvantaged, helpless, or abandoned.”
“Some patients receive treatment in private wards first and later obtain compensation recommendations. Is there any action against such recommending authorities?”
“We only claim that we follow the 10% free bed policy, but what is the reality? We provide hospital services, yet patients are forced to purchase services. Why is that?” Dahal questioned.
Dr. Samir Kumar Adhikari, spokesperson for the Ministry of Health, said some private hospitals perceive the policy as a new regulation.
“We are only trying to systematize and bring transparency to an existing provision,” he clarified.
Dahal expressed willingness for private hospitals to cooperate with the government but emphasized the need for extensive discussion on unresolved issues.
Questions remain on why the 10% free service burden has not been extended to other service areas, as raised by private hospitals.
“It is right that the prime minister focuses on providing relief to the needy, but the implementation challenges must also be addressed,” they said.
Progress So Far
According to the government’s governance reform ten-point agenda, the Ministry of Health has recently developed the ‘Free Health Portal’ to ensure real-time monitoring of free service availability, beneficiary details, and service utilization at all health institutions.
As of Friday morning, the portal showed a total of 3,478 free beds available nationwide.
However, only about 800 of those beds were in use, while the rest remained vacant.
“Since the portal was launched, around 5,000 people have accessed free services,” Ministry spokesman Dr. Adhikari reported.
The ministry has publicly listed contact persons from relevant hospitals on the website to ensure the beds allocated are utilized.
The ministry advises contacting Dr. Joshi (mobile: 9851460037) if any issues arise.
“We strive to make services easily accessible to the designated target groups,” said Dr. Joshi. “Once AFIN’s concerns are addressed, the service will become even more accessible.”
What Services Are Provided?
To avail services under this provision, indigent patients require an indigent ID card or a recommendation from the local government.
Helpless and abandoned patients are transported to hospitals by security personnel, according to Dr. Adhikari.
“One can check whether free beds are available via the ‘Free Health Portal’ or inquire at the hospital itself,” he added. “If the [10%] free beds are fully occupied, the service cannot be provided.”
Under this regulation, hospitals are required to provide all available services free of charge.
“This includes medical consultation, surgery, hospital beds, and medicines.”
Complaints may be filed with the Ministry of Health or local authorities if services are not provided. “Complaints are facilitated and action taken according to the rules.”
“We emphasize mutual understanding between service providers and recipients to ensure smooth service delivery,” Dr. Adhikari stated.
Former senior public health administrator Bhandari stressed the need for stronger monitoring to enhance the effectiveness of this policy.
“Previously, people accessed services based on connections or hospital staff acquaintances. To reach the targeted groups, public awareness, strict enforcement, and monitoring are essential.”