Hari Duwal of Bharatpur had reached the OPD counter of Bharatpur Hospital at 11 am on Monday to stand in line for an eye test. He has health insurance. After standing in line, he found out that the insurance server was down. After standing in line for an hour, not seeing any work, he went home saying, "I will come tomorrow." Such a problem happens again and again here.

The number of people with health insurance who come to get services at the Federal Government Hospital in Bharatpur is very high. According to the hospital's information officer, Gopal Prasad Poudel, the total number of people who came to the hospital's OPD for services on Sunday alone was 1,979. Out of which, 1,396 were insured. On Tuesday, Kartik 11, this number was even higher.

That day, about 3,000 or 2,850 people came to the OPD. Out of which, 2,228 were insured. That is, 78 percent of the people who came to the OPD had health insurance. According to Liladhar Poudel, head of the health insurance unit of Bharatpur Hospital, In the past, 70 percent of those who came to get services used to have insurance. Now, the average is 75 percent.

The health insurance program was started at Bharatpur Hospital in 2074 BS. In the fiscal year 074/75, it is seen that those with health insurance used to get services 32,602 times. In the last fiscal year, this number reached 441,308 times. After paying Rs 3,500 per year for health insurance, five family members get treatment, tests and medicines worth Rs 100,000.

The hospital's experience in the eight years since it started the health insurance service has not been pleasant. The number of patients visiting the hospital has increased dramatically. This is a good thing. "But the health insurance program is not suitable to be run the way it is now," said Dr. Krishna Prasad Poudel, Medical Superintendent (MESU) of Bharatpur Hospital. Although health insurance has made many things easier, both the service provider and the service recipient are dissatisfied.

Balram Pokhar appeared on the Bharatpur Hospital premises on Sunday afternoon. He is 55 years old and a resident of Bharatpur Metropolitan City-5, Narayanpur. He had come to the hospital for treatment because he had a toothache and cough. He has had health insurance for five years. He has been renewing it every year. "I see the benefits from it. That is why I have been taking the service," said Balram.

He and four others in his house have treatment facilities worth Rs 100,000. He also brings his wife to the hospital from time to time. ‘But there are many people who come for treatment. There are long lines and crowds. If you have to show two or four places, it will not work in a day,’ he said. In addition, he complained that not all the medicines prescribed by the doctor are included in the insurance.

‘Before this, I had a problem with intoxication and had to get an MRI. I had to wait for two and a half months for that,’ he said. He shared his experience that insurance is good for tests and treatment despite the crowds, time-consuming, and not getting some medicines.

46-year-old Shila Shrestha of Krishnapur, Bharatpur-7, said the same thing. She came to the hospital for treatment after having problems with leg and neck pain. Shrestha, who got health insurance five years ago, has to come to the hospital for treatment like every year. ‘Insurance has provided some facilities, but it is annoying to have to wait in long lines. Not all medicines are available, but it did not cost much to get tested, and tests were also done. This was good because of the insurance,’ said Shrestha.

Hospital facing payment problems 

Hospital manager Dr. Krishna Prasad Poudel said that the amount of those who come to Bharatpur Hospital for treatment through insurance is 70 million rupees per month. But he complained that the problem in management has increased due to non-payment on time. ‘Sometimes we do not receive payment from the Health Insurance Board for 6 months. How will the hospital run in this situation,’ Dr. Poudel asked.

He said that the Health Insurance Board has not paid 60 million rupees till Asoj even now. He said that the hospital has not been able to do other work due to the suspension of payments due every month. ‘Insured people receive treatment worth 70 million rupees per month. The monthly income from those who do not have insurance and pay in full is around 30 million rupees,’ he said.

He said that the hospital has been covering its expenses from this income. ‘Thankfully, our hospital earns a fair amount of income. Land rent is collected. There is also income from educational programs. Patients should also pay fees. If we had relied solely on health insurance, it would have been difficult to pay salaries here,' he said.

There are more private sources of manpower than posts in Bharatpur Hospital. According to Mesu Poudel, 1,211 employees, health workers and doctors are working in Bharatpur Hospital.

There are 400 employees in this 600-bed hospital who are paid from government sources. Poudel said that the rest are being paid from the income generated by the Hospital Development Committee. Therefore, since the insurance payment is not regular, the income of the Development Committee is being spent on salary allowances.

'As the number of people coming for services increases, the hospital will have to add manpower, tools, equipment, buildings and rooms. If the insurance payment was regular, we would have been able to mobilize our income there. But due to the delay in payment, we have to keep the income for salaries,' said Dr. Poudel. Therefore, he said that there is a problem in the management of health insurance.

Health insurance policy should be improved

The number of people taking health insurance in Chitwan has reached millions. Dol Kumari Poudel, coordinator of the Health Insurance Board District Liaison Office, Chitwan, informed that 569,836 people have health insurance in the district. This includes the number of permanent and temporary residents of Chitwan. According to this number, the pressure on hospitals seeking services is certain to increase.

Bharatpur Hospital alone has four counters in the OPD for insured people and two for those who are not. Similarly, there are six counters for insurance and two counters for uninsured people for stamping and cash payments. “The number of patients coming here is why we are facing difficulties. How will we handle more than 2,500 patients?” said Mesu Poudel.

He suggested that arrangements should be made in the insurance policy to reduce this pressure. Currently, there is a rule that those who come for treatment with insurance should bear 10 percent of the expenses. He says that this should be increased further. “There is a mentality that if we are told that there is a facility of one lakh rupees, we should use it all. 1,500 samples come to the lab in a day. How can we handle it like this?” said Poudel.

He says that even if insured, there should be a provision for the service recipient to bear 30 percent of the costs of tests and other expenses. He also said that this rate should be increased even more when doing MRI. ‘They try to take expensive services like MRI. Since the co-payment is low, the practice of unnecessary tests has increased,’ he said.

If co-payment (which insured service recipients also bear) is not to be kept, he said that a policy should be introduced where insurance covers only certain services. ‘There should be a policy where patients pay for basic tests, but insurance covers services such as treatment of serious and severe diseases, surgeries that are costly,’ Mesu Poudel suggested. He said that this suggestion was put forward in the ministry and board meetings and was also mentioned repeatedly in the meetings.

Pradeep Poudel, who came to participate in a program at Bharatpur Hospital when he was the health minister last Baisakh, also complained that 40 billion rupees would be required to run the insurance program in its current form, but the Finance Ministry had set a ceiling of only 10 billion rupees. He also said that the insurance program cannot run in the current situation.