Treat the people, protect the budget

Similarly, even though it is stipulated in the fundamental rights that every citizen will have equal access to health services, health treatment is a challenge for most Nepalis. Healthcare is neither free nor guaranteed access to treatment. In case of a more complicated disease, the citizens will not only suffer, but will also suffer from weakening of their economic status. As the basic right of the constitution is health care, the greatest challenge of Nepali people is that the adoption and trust of the citizens towards the state has weakened. As long as this disorder persists, the bond between the state and the citizen will weaken.

The government started the health insurance program in 2072 to manage citizens' easy access to health care and to minimize personal/family financial risks. Although this program is commendable from the point of view of concept, the implementation has been weak. Not only private hospitals, but also government hospital employees have been criticized for abusing the program to get unfair financial benefits from insurance funds for treating citizens.

Similarly, many individuals and families have the mentality that they must take the service according to the insurance facility even if they do not need it. As a result, government resources have not been respected. Likewise, the payment to the hospital of the obligation ensured by the government from the treatment of citizens is also being delayed. It is inevitable that the insurance program, which is ineffective due to many reasons, should be made effective in such a way as to justify it.

The initiative taken by the state in the treatment of citizens has not been meaningful, but this does not mean that the cost has been reduced. About 28 billion 500 million rupees are spent annually on half a dozen programs for treatment. 6 billion for the treatment of eight types of complex diseases, 7.5 billion for health insurance subsidies, 3 billion for mother protection program, 2 billion for free treatment given to the poor, helpless and disabled, 1 billion for heart treatment for children under 15 years old and 1 billion for treatment for those over 70 years old, dialysis, paralysis and Those who are undergoing cancer treatment spend about 2.5 billion rupees for medicines at the rate of 5 thousand per month. In this way, even when grants are given under different titles, treatment is not guaranteed and the budget is not saved. Therefore, Health Minister Pradeep Paudel has said that he has proposed to introduce a one-door system to cover all the programs under the social security program.

There is a situation that cannot be addressed without addressing the current weaknesses in the implementation of the health insurance program. Only if costs and effectiveness of treatment can be reconciled, both the health of citizens and the state budget will be respected. For this, there is a need for homework to ensure health care by integrating the grants that are operating from different systems. For this, transparency in the overall process is essential. Similarly, the current weakness of the health insurance program needs to be reviewed and improved.

So far, only 28 percent of the population has been connected to the health insurance program, which has received a lot of attention. So far, 8.1 million people have joined the insurance program, but only about 70 percent have renewed it. It seems that there is a problem with this program due to the lack of interest in the renewal, or the public lacks enthusiasm or the specific purpose of the program has not been explained to the public. Therefore, how can more people be connected to the integrated insurance system by creating trust in it, is a matter of waiting. People's attraction can increase only if it is affordable and beneficial for the people. Policy clarity and consistency in the understanding of the stakeholders is necessary. Only through that, this new thinking can be managed practically.

A third and important topic, securing sources is challenging. According to the health minister, if the various programs that are currently running are brought together, a budget of around 30 billion will be ensured and the remaining amount is being studied. It remains to be seen how much success he will have.

Fourth, in the schedule of the new constitution, health is also placed in the common list of rights of the union, state and local levels. Therefore, any program connected with this should ensure the ownership and responsibility of all three levels.

Fifth, the services and facilities specified in the hospitals that will be connected to the integrated insurance system should be flexible. Going to an insured hospital, but not getting the necessary services or having to depend on an external system, cannot create attraction and achieve purpose. On the whole, no matter how good the plan the Ministry is thinking of now, continuity or further improvement must be its first condition. If the program is implemented, it should not be a situation where the service recipient (patient) has to face unnecessary hassles. At the center of the new system should be the objective of providing accessible and quality healthcare to citizens.