We use Google Cloud Translation Services. Google requires we provide the following disclaimer relating to use of this service:
This service may contain translations powered by Google. Google disclaims all warranties related to the translations, expressed or implied, including any warranties of accuracy, reliability, and any implied warranties of merchantability, fitness for a particular purpose, and noninfringement.
Prashant Mali of Kantipur had a conversation with Health and Population Minister Pradeep Paudel about the latest situation of the Health Insurance Board.
It seems that the payment claims in the health insurance board will reach 24 billion by the middle of the current year. Now only 1 billion is left in the fund . The Ministry of Finance allocated only 10 and a half billion budget in the current year . How will you manage the amount if you do not allocate more budget in the next year than the current year?
About 13 billion rupees of last year's arrears remain . It seems that 2 billion rupees have been spent in the month of July 2081 alone. If we assume that 2 billion is spent in one month, then 24 billion is spent in 12 months . 24 billion in 2080/81 and 13 billion in 2079/80 and 37 billion in arrears. The Ministry of Finance does not seem to be in a position to allocate 7.5 billion budget like the previous Minister of Finance and pay insurance. So this time, 40 billion rupees had to be allocated for insurance. If that is not possible then we have to implement the proposed program .
What did you propose to the Ministry of Finance? It is necessary to develop a system of regular income of
insurance and income according to need. That is to develop a contribution based insurance system . Connecting insurance to all citizens, connecting the organized sector to pay salaries. Applying progressive premiums to those who can pay slightly higher premiums . The government will set premiums on average and connect citizens who are unable to do all these three things to insurance by paying premiums. The sources of various other parties will also be added to the insurance. We should move forward by developing a systematic system that does not allow lying.
It has been decades since the social security program was implemented through a single system. What is the reason for not being implemented yet? It is said that this program will be implemented from next July 1. How are you prepared?
We have made a plan to run the social security program through a one-door system . We are clear on content . Before this, it was difficult to implement due to ambiguity in the content . There are various programs behind this ministry. It is our opinion that all health programs should be conducted only through the insurance board. For example - Social Security Fund, Provident Fund, Army, Police's various welfare funds for health should go to the Insurance Board . All those funds will be affiliated with the Insurance Board. Through that, health treatment should be conducted in an integrated manner. 6.6 million Nepali households should be included in the insurance. Relation with the state is established only after being connected with Bima . Even if you have to take citizenship, passport, birth certificate, death certificate, you should make a rule that insurance board should be affiliated.
The main reason for the failure of the insurance board to operate properly is irregularity. Fake claims are increasing every year even in the annual returns of insurance . What is the plan to control it?
Even those who have not been treated will sign that they have been treated, and the hospital that has not been treated will also take payment saying that they have been treated. False claims are illegal. There was no trust in health care. Hospitals used to charge more as soon as they were insured. Reluctance to seek treatment . Behavior is not good . It did not earn credibility .
If all this is not corrected, it will not be organized . The first and second year the insurance was started went well . Because it had reached the amount given by the government as needed. Now the amount given by the government is not even 20 percent. That's why the insurance started sinking . It had to have regular income to save the sinking insurance .
The state should give special priority. It should be taken forward so that the executive role will be played by the insurance board and the regulatory role will be played by another party. As far as the issue of fake claim is concerned, it should be investigated whether there is/is not fake claim in the previous payments. Even now fake claims who do . If they start taking strict action, no one will dare and it can be organized .
What more plans are there to reform the insurance board?
Regular income, operating through integrated and one-door system, providing the required staff organization and management survey (O&M) immediately. Bringing it forward by organizing the organizational structure. The insurance board package is not viable . Change it and make it practical . Strict action will be taken against both the person making the fake claim and the hospital . If it is found that the money has been taken by making false claims, the contract of the hospital will be canceled . Making it easy to join the insurance, we are making arrangements to be able to refer from where the person lives. We have already started working by making a mechanism to change other piles.
