The arrears of the Health Insurance Board have reached 24 billion rupees. About 2 billion rupees worth of claims come to the board for payment every month. According to this calculation, it seems that the arrears will reach 26 billion rupees by the end of June.

Adding the arrears of 26 billion rupees for the current financial year, the amount to be paid by the end of the next financial year will reach about 50 billion rupees. The board now has only two billion rupees in its account. The Ministry of Finance has allocated 10 billion rupees for the coming year. It is estimated that about 4 billion rupees will be collected annually from the premium. In this calculation, it seems that about 34 billion will be insufficient to settle the arrears by the end of the next year.

The number of renewals of the insured is decreasing

According to the provisions of the Health Insurance Regulations, 2075, the insurance must be renewed every year after becoming insured. However, the renewal rate of the insured is decreasing every year. The number of new insured has not increased significantly. According to the census of 2078, the population of the country is 291 million 64 thousand 578 people. In the 9 years since the insurance program started, the number of insured people in 2080/81 is only 82 lakh 92 thousand 141 in 2080/81. Renewal number of insured was 75 percent in 077/78 . Reduced from 64 percent in 078/79 to 59 percent in 079/80 . In 080/81 it fell to 54 per cent, according to the board .

'Fake claim on the rise'

Hospitals are making double claims for the amount of free health insurance program conducted by the government, making fake bills and demanding payment from the board . According to the data, in 078/79 there is 14 crore 65 lakh rupees, in 079/80 16 crore 3 lakh 61 thousand rupees and in 080/81 there is 16 crore 36 lakh 82 thousand rupees claim rejected amount (fake claim).

In the year 080/81, 67 percent of the disapproved amount is in government hospitals (10 million 91 lakh 62 thousand rupees), 6 percent in community health institutions (1 million 72 thousand rupees), 27 percent (4 million 44 million rupees 48 thousand rupees) in private hospitals . Most of the fake claims seem to demand payment for diabetes, stomach, throat, chest, muscle, joint, vein, bone pain, thyroid, high blood pressure and other diseases .

Expenditure is more than income

The board's income and expenditure statement looks at a loss for 3 years . It seems that in the year 078/79 it was 10 billion 96 crore 98 lakh rupees, in 089/80 it was 13 billion 56 crore 80 lakh rupees and in 080/81 it was 10 billion 67 crore 10 lakh rupees . It seems that the expenses were 10 billion 597 million rupees, 17 billion 52 million 14 million rupees, 13 billion 16 million rupees and 13 billion 165 million rupees respectively in the financial years.

Claim amount based on gender

When analyzing the number of insured claims on the basis of gender, the number and amount of women's claims is higher. In the year 081/82, the total number of claims is 69 lakh 87 thousand 991, the number of claims by women is 57.15 percent and the claim amount is 55.91 percent, that is 7 billion 79 crore 32 lakh 82 thousand rupees. The number of male claims is 42.84 percent and the claim amount is 44.09, i.e. 6 billion 14 million 54 lakh 39 thousand rupees. The number of claims of sexual and sexual minorities is 644 and the claim amount is 11 lakh 73 thousand rupees, ie 0.01 percent only.

Number of claims and amount based on age

In financial year 081/82, the number of claims and the amount of claims in the age group of 55-59 years are more than other age groups . The total number of claims is 69 lakh 87 thousand 991 and the claim amount is 13 billion 93 crore 98 lakh 95 thousand rupees, the number of claims of this age group is 6 lakh 26 thousand 657 i.e. 8.97 percent . The claim amount is 9.30 percent i.e. one billion 296 million 89 thousand rupees.

The percentage of the age group above 95 years of age, the number of claims and the percentage of claim amount is less than others . The number of claims of this age group is 0.18 percent i.e. 12 thousand 681 and the claim amount is 0.23 percent i.e. 3 crore 19 lakh 91 thousand rupees. Although the number of claims and the percentage of the claim amount in the age group of 90-94 years are relatively low, the average amount per claim is 2 thousand 571 rupees. According to the Health Insurance Board, the main reason for this is that there are many chronic diseases such as heart, kidney, cancer, spine injury, asthma in this age group . Claim amount based on the type of

insured When analyzing the claim amount based on the type of affiliation in

insurance, it appears that the claim amount is 11 billion 40 million 42 lakh 41 thousand rupees from the general insured. Which is 79.23 percent of the claimed amount. It seems that 20.77 percent i.e. 2 billion 895 million 53 lakh 16 thousand rupees have been claimed from the target groups such as the very poor, senior citizens and the disabled.

The insurance program started by the government from Chait 25, 2072 in Kailali district has now been implemented in all 77 districts. Based on the payment of 3,500 per family (up to 5 persons), there is a provision for health facilities of up to 1 lakh per year and additional services of 20,000 per member if the amount is increased at the rate of 700 per member. The maximum service facility limit is up to 2 lakh (10 family members). The insured has to pay 2 percent amount for the service . The insurance program is applicable to government health institutions and private medical colleges.