Previously, there was a provision that people with health insurance could spend as much as they wanted in the OPD.
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Health insurance beneficiaries will now be able to avail outpatient (OPD) services of up to Rs 25,000 per year. The Health Board has announced that the decision has been taken to control expenditure due to the economic crisis and increasing financial burden.
The board has now stated that the OPD service in the facility bag has been fixed at a maximum of Rs 25,000 per family per year for five people and Rs 5,000 for each additional member. The board has stated that this rule will come into operation from 1 Falgun. In addition, the board has stated that the remaining services that can be used through Intimate Services (IPD) and Emergency Health Services remain the same. According to the board, the decision was made at the board meeting held on 24 Poush with the aim of making the service consumption of citizens more effective and reducing the cost burden. The board has stated that this rule will come into operation from 1 Falgun.
Earlier, there was a provision that people with health insurance could spend as much as they wanted on OPD. From 1 Falgun, if the expenditure on OPD services exceeds Rs 25,000, the patient will have to pay the fee and undergo additional treatment. The board has stated that the treatment of 8 types of serious and chronic diseases will continue as per the current arrangements as per Schedule 6 of the Insurance Regulations.
According to the treatment provided by health insurance, 71 percent of the insurance amount is spent on OPD. 10 percent is spent on IPD and 10 percent on emergency services, according to the Health Board's data.
According to the Insurance Board's Information Officer, Bikesh Malla, currently about 12 billion rupees are outstanding from 510 service providers affiliated with the Health Insurance Board.
According to Malla, the effort is to systematize the expenditure on OPD and focus more on serious treatment such as isolation and ICU.
The government had provided an annual grant of 10 billion rupees to the board for the current fiscal year. Meanwhile, more than 24 billion rupees are spent on the insurance program every year.
