सिंहदरबार संवाददाता
Kathmandu. The public statement made by Health and Population Minister Pradeep Poudel a few days ago about health insurance has now become controversial.
At a program of the Nepal Pharmaceutical Wholesalers Federation held in Kathmandu last week, lawmakers also raised their voices in the House, saying that the statement he made raised questions about the future of health insurance.
According to the Health Insurance Board, health insurance, which started in Chaitra, 2072, has now reached 77 districts. With 8.9 million people enrolled in health insurance across the country, 484 health institutions, including 48 private ones, are providing services to the insured. There is a suspicion that the program itself will be closed if the leader of the Talukdar Ministry makes a controversial statement about this program.
According to board officials, the service providers currently have to pay 15 billion. Public Health Officer of the Board, Bikesh Malla, said that due to lack of budget and inability to conduct evaluation on time, payments to health institutions have not been made.
He said, “There is not enough money in the Health Insurance Fund. We have made payments for Ashar, but we have not been able to do it since Shrawan. It is also difficult to conduct evaluation for prompt payment. The reason for the delay in reviewing and evaluating payments is due to the lack of manpower. There are 25 employees in the Claims Review Committee, including doctors and nurses. The number of claims comes in at 30-40 thousand daily. Due to the lack of staff, there is a problem in verification.”
There is no shortage of problems in the Board. Even hospitals are finding it difficult to get paid, and confusion has increased after Health Minister Poudel expressed that the hospital’s dues cannot be paid.
The Minister’s statement
Health Minister Poudel faced controversy when he made a statement regarding the payment of health insurance.
He had said, ‘Payment of health insurance is not possible. How much has the state committed, not seven and a half billion. How much has been spent today? How can we pay the arrears of the previous year, which are not included in this year’s budget? 16 billion rupees, the arrears of the previous year, were to be received this year after I came. Payment has been made. Like the pickles kept in food, even this is not enough. There is no excuse, insurance is being implemented here too, it is being said that it is being implemented. Citizens have even said that they will not do the test, they have spent money.’
He had said that there has been an increasing trend of hospitals making the insured pay for buying medicines that do not need to be bought. He had also said that hospitals are making patients undergo unnecessary tests to collect insurance costs.
Even facing questions in Parliament
Rastriya Swatantra Party MP and former Minister of State for Health Toshima Karki said that the health insurance program should not be stopped under any circumstances.
Speaking in Parliament on Monday, he said, “The Health Minister, who shared the ambitious dream of increasing the health insurance limit to 500,000, has now started saying that this payment cannot be made, the budget is not enough, and the insurance is about to be closed. It is sad to hear this statement made by him helplessly. It is not good to try to claim that we brought health insurance when this program is running, and now it is being abandoned and only 27/28 percent access has been maintained for years, and then become discouraged after making it a disaster until today.”
According to him, health insurance should be implemented for everyone. It should start with the Health Minister and the employees working in his secretariat. If the population across the country takes out health insurance, it is seen that 20 billion rupees will be collected annually. He said that there should be no delay in paying the arrears that are currently seen.
What does the Health Minister say after the controversy?
Health Minister Pradeep Poudel said that he did not say anything about stopping health insurance payments. He said, “When I spoke in detail in the program, the middle part of the speech came out, especially that only health insurance can make Nepal’s health sector effective. A person like me who believes that effective, simple, cheap and free treatment can be provided to citizens cannot talk about abolishing health insurance.”
He said that he was trying to say that health insurance does not work in this way.
He said, ‘Along with this, it is necessary to organize its funds. It is necessary to secure its funds and remove all the irregularities that exist here. Health insurance should be able to create a situation where many citizens contribute. Many citizens contribute, those who cannot contribute and those who cannot. By arranging for free premium payment, now when a citizen spends 100 rupees from his pocket, 55 rupees are spent on treatment. Now we should create a situation where citizens can be treated for 20 rupees from the insurance that we have. Therefore, we will not end the insurance, but we will organize the insurance.’
He also said that health insurance will be organized and arrangements will be made for treatment only from that insurance.
Insufficient budget for health insurance
The government has been providing insufficient budget for health insurance. It has been providing 7.5 billion rupees to the board annually, while 3 to 4 billion rupees have been collected from the insured.
Board officials say that even that amount can be used to pay the old amount. While the board’s data shows that more than 13 billion rupees are spent on health insurance annually.
According to them, the government has not been able to cover all citizens, including civil servants and families of workers who have gone for foreign employment, with insurance.
Moreover, the government has not paid the board the amount for the contributions of the severely disabled, disabled, HIV-positive, people over 70 years of age and women volunteers for 2 years.
Officials say that the problem has arisen because the government itself has not paid. Health Ministry spokesperson Dr. Prakash Budhathoki said that the budget is being requested from the Finance Ministry as per the requirement. According to him, there is not enough in the budget for the board itself.
He said, ‘The amount received by the hospitals will be paid after the claims are authenticated. Even now, the Insurance Board has a budget of one and a half billion to pay health institutions. After the board has paid that money to the health institutions, it should request additional funds from the Ministry of Health, and the ministry will request it from the Finance Ministry. After the Finance Ministry has released the funds as required, the board will be paid by the Ministry of Health, and the board will give it to the health institutions.’
This is how health insurance started
The government had started a family-based health insurance program since Chaitra 2072. Currently, health insurance has been expanded to 753 local levels in 77 districts.
Under health insurance, families with up to five members can receive free treatment of up to Rs 1 lakh annually by contributing Rs 3,500.
If there are more than five members, each additional member pays a premium of Rs 700, up to Rs 20,000 for free treatment facilities of up to Rs 20,000 per member.
The government has implemented the ‘co-payment’ system from 2080 Magh 1, according to which the insured must immediately pay 10 percent of the expenses incurred during treatment to the service provider within the insurance limit.
In Nepal, the government still bears about 45 percent of the expenses incurred in drug treatment provided by government health institutions, while the patients themselves bear about 55 percent of the expenses.
The Nepali Congress has been taking the lead in this program. Health Minister Poudel himself had presented his plan for health sector reforms at a press conference at the ministry on July 27, 27 days after assuming office, during which he proposed increasing the insurance coverage to Rs 500,000. Minister Poudel had presented the action plan for health insurance reforms to the Prime Minister last January.
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