The government must be accountable to the insured. For that, agencies like Ministry of Health, Health Insurance Board and Drug Administration Department should monitor and take action against the culprits. Hospitals that do not provide facilities as per the agreement must be strict.
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The main objective of the government to start the health insurance program in 2072 was to manage citizens' access to treatment and minimize personal/family financial risk. Since then, the program has been gaining popularity, but it has started to gain notoriety due to the fact that the insured did not get the expected and specified benefits.
To some extent, the insured who are being treated in many government hospitals are not able to get the medicine prescribed by the doctor in the pharmacy there. Complaints are increasing that when you go through the long line of the pharmacy and barely reach the place where you can get the medicine, you cannot get the medicine that is relatively more expensive.
It stabilizes the patient. Necessary medicines have to be bought expensively from private pharmacies. The credibility of this program has been lost due to non-availability of facilities under the health insurance program. The insured is being cheated. The people mainly connected with insurance have to bear the harassment and additional financial burden.
Due to this trend, there is a suspicion that the insurance program will have difficulties to continue in the status quo. Therefore, it is the responsibility of the government to ensure that the people who are connected to the insurance by paying the prescribed fee also get the prescribed service facility. This requires additional activation.
health insurance program was started from Kailali on Chait 25, 2072. Now it has been expanded and implemented in all 77 districts. On the basis of paying 3 thousand 500 rupees per family (up to 5 people), there is a provision to provide health facilities up to 1 lakh rupees per year and if the amount is increased at the rate of 700 per person, services equal to 20 thousand per person will be added.
The maximum service facility limit is up to Rs 2 lakh (family members of 10 members). There is a rule that a 10 percent fee must be paid for the service. 440 health institutions have joined this program. They also have an agreement with the Health Insurance Board to provide services under the insurance program.
Health insurance regulation, paragraph-6 of 075 has a provision that the service provider should arrange a pharmacy to provide medicine 24 hours a day and it should be in accordance with the standards set by the government. However, if even the prescribed medicine is not available, it shows the arbitrariness within this program.
If we look only at the law, policy and its theoretical interpretation, the insurance program appears to be very beneficial. Some problems should be effective and agile over time. The attraction towards it should increase. But in the case of insurance programs, the opposite is happening.
has been criticized for several wrong trends and weaknesses in its practice. The attraction is waning. For example, in addition to the problem of the patient not getting the medicine from the pharmacy of the hospital where he is being treated, it is also complicated because he has to connect with the referral system.
Because a person can get sick no matter where he reaches, the compulsion to go through the initial hospital route is not a convenience, but in some cases it only brings suffering. The problems caused by the hospital claiming higher fees from the government while treating the patients covered by the insurance or the government not paying the hospital on time have also raised questions about the continuity of the insurance.
It is also clear from the data. Now the total insured number is only 46 lakh 66 thousand. The number of renewals of insured was 75 percent in 2077/78, 64 percent in 2078/79 and 59 percent in 2079/80. The Health Insurance Board has not released the data for 2080/81. To increase the attraction towards this program, the government needs to make a strategic plan and implement it immediately.
Not only in hospitals outside the Kathmandu valley, medicines are not easily available in the pharmacies of major hospitals in the country, including the well-known hospitals in Kathmandu, including Dharm Bhakta National Human Organ Transplant Center Bhaktapur, Tervi Teaching Hospital, Kanti Children's Hospital, and National Trauma Center. The insured has also complained about it. According to the data of the Health Insurance Board, from July to December 26, more than 15,000 insured people have complained that they have not received services as per the contract. The number of
complainants also shows that there is a huge problem with insurance coverage. Reasons like prescription of medicine by the doctor, price fixed by the insurance board, commission game are mentioned to solve the problem. It is the government's responsibility to make improvements where it needs to be made and to make them mandatory where they need to be made.
The government must be accountable to the insured. For that, agencies like Ministry of Health, Health Insurance Board and Drug Administration Department should monitor and take action against the culprits. Hospitals that do not provide facilities as per the agreement must be strict.
