How to raise health insurance resources?

In this article, it will be discussed how it is possible to provide quality and accessible health services to the general public by improving health services in Nepal through health insurance.

The government started a family-based health insurance program from Chait 2072. According to the Economic Survey 2080/81 published by the Ministry of Finance, almost 2.4 million families across the country have come under the scope of health insurance till last February. The total number of insured has exceeded 77 lakh and more than 36 lakh have taken health insurance services. Now health insurance has been extended to 753 local levels in 77 districts. Under

health insurance, families with up to five members get free treatment up to one lakh rupees per year by contributing Rs 3,500. If there are more than five members, if each additional member pays a premium equal to 700 rupees, each member will get free treatment facility up to 2 lakh at the rate of 20 thousand rupees. The government has implemented the 'co-payment' system from January 1, 2080, 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, even now, the government covers about 45 percent of the cost of medical treatment provided by government health institutions, while about 55 percent of the cost is covered by the patients themselves. As in Nepal, in India too, patients spend 55 to 60 percent of their own pocket money on healthcare. In Pakistan, patients spend 65 to 70 percent on their own health care. In both of those countries, the voice is being raised to increase more investment in the health sector.

We have seen examples of having to sell the farm when health treatment is expensive, taking loans from moneylenders at high interest rates, and some families falling below the poverty line while undergoing treatment. According to the National Statistics Office, nearly 20 percent of Nepal's total population, i.e. 6 million people, are below the poverty line. It is the government's responsibility to provide quality healthcare to them. Also, a large number of Nepalis go to India every year to get specialized services such as cancer. Some of the financially prosperous go to countries such as Thailand, which is also called 'medical tourism'. In this way, it is estimated that the amount going abroad is huge.

According to the Health Insurance Board, currently around 75 lakh citizens are covered by health insurance across the country, which is almost a quarter of the total population. The main problems at present are the inability of government hospitals to provide prompt health care, lack of timely treatment, long waiting times for services such as surgery, and low insurance coverage. Similarly, the listed hospitals have been complaining that they have not received payment from the health insurance board for months, and the board suspects that the hospital has exaggerated the insurance amount. This problem can be addressed by testing the claims made by hospitals based on a reliable standard.

international experience

In the case of Nepal, there is no alternative to increasing the insurance amount, coordinating with provincial and local bodies and expanding health insurance in collaboration with the private sector as well. We can also learn from international experience on how to make this service effective. In 2002, Thailand introduced 'universal health care' (UHC), which requires consumers to pay 30 baht per visit.

However, since 2006, the system has been removed and made free. Currently, about 99 percent of the people in Thailand receive free health care, and the government provides health care through taxes it collects. For Indonesia's health insurance scheme (Zaminan Kesehatan Nasional – JKN), the central government collects premiums from formal sector workers and informal sector participants. The state itself pays the amount for the premium of the low income category.

In the state of Kerala, which is known for the most quality and efficient health services in India, from July 2020, the state government implemented the 'Karunya Arogya Suraksha Padathi (KASP), under which health services worth 5 lakh rupees are available to every family every year. It covers the cost of medical tests and medicines from three days prior to hospitalization and up to 15 days after discharge. This service covers the whole family and the service is available from listed government and private health centers. The Kerala government is bearing the cost of this scheme by integrating the subsidy received from the central government and health services under various headings.

In Nepal, the state spends only about 5 percent of its gross domestic product (GDP) on health care, which is very low by international standards. America spends 17 percent of its GDP on health. According to the World Bank, Cambodia spends about 8 percent of GDP, Brazil more than 10 percent, and Switzerland, Germany, and the UK spend 11 to 12 percent of their total GDP on healthcare.

Possible source

With a population of over 100 million, Sweden's GDP is about $623 billion. Countries like Sweden and Norway have been providing free and quality services to citizens by spending up to 11 percent of their GDP on healthcare. It is not possible for Nepal to double the investment in the health sector right now, but it is possible to increase the current health insurance amount by improving health services, reducing leakages and integrating social security and health services. As the size of the economy increases, the ambition of doubling the investment in the health sector in the next 5/7 years must be maintained.

More than 1 million Nepali workers employed abroad are affiliated to social security scheme based on contribution, and more than 63 billion rupees have been collected in this fund. It seems that efforts should be made to cover the families of Nepalis working abroad in health insurance in cooperation with the Social Security Fund.

If health tax fund is added, tobacco tax, mandatory tax on food and beverages used in sugary products and integration of health program under various headings, enough resources can be raised for health insurance fund. If 1 or 2 percent of income tax revenue is earmarked for health insurance, it will help ensure resources. Also, if health insurance is mandatory for government employees and a fixed percentage contribution of salary is arranged, it will help in sustaining the insurance program and will also send a positive message.

if not now when?

The announcement made by the Health Minister of the new government, Pradeep Paudel, to increase the amount of health insurance to five lakhs, has been criticized by some sectors as not based on reality and the government cannot implement it. But even this government could not dare and if sufficient resources are not ensured to expand the health insurance scheme, there will be no place to expect much from the future government.

ing Effective health insurance is the need of the day. As mentioned above, health insurance is not an option. It seems that the program should be carried forward by making short-term and long-term plans for families who can mobilize resources according to certain criteria and free for those who are below the poverty line. By widening the scope of insurance, if all Nepalese are provided compulsory insurance and quality health services are provided in the country, a huge amount of money can be saved which is currently being spent on health treatment abroad.

This results in the return of the government's investment in health. Currently, the government is spending twice as much when it runs separate programs. Therefore, it is necessary to operate the health services that are provided free of charge by the government through a one-door system. The government should move forward by improving the shortcomings in health insurance. This step will prove to be a milestone towards achieving the Sustainable Development Goal of providing healthcare to all by 2030.

– Paudel, former president of NRNA America, is a senior physician and healthcare management expert.