The success of this program can only be ensured if the trust is developed that the insurance minimizes the financial risk that the citizens are facing for health treatment, quality healthcare is ensured and the service is easily available.
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Health care is so expensive that common people are struggling financially. Although it is written in the fundamental right of the constitution that every citizen will have equal access to health services, the biggest challenge of citizens is in health services.
Many families are pushed towards poverty every year due to the expenditure on health care. This risk was expected to be covered by the insurance program. Due to its original purpose, it has also garnered praise in the beginning. Due to the lack of efficient management, the liability of the Health Insurance Board is increasing, now the arrears have reached 17.42 billion rupees.
Since the establishment of the board in 2072 till 2079/80, 11 billion 62 crore 77 lakh 10 thousand rupees have been collected from Premier. However, up to this period, the expenditure has been 40 billion 736 million 23 thousand rupees. It is certain that the insurance program will not be strong from this practice. About 30 million claims of 25,000 to 30,000 insureds are received on the
board daily. However, the rate of joining or renewing health insurance programs is declining. In the 9 years since the insurance program started, the total number of insured is only 34 percent, that is, now there are 99,23,000 insured. Renewals were seen at 75 per cent by 2077/78, falling to 64 per cent in 2078/79. It further decreased to 59 percent in 2079/80. The board has not released the data for 2080/81. The available data shows that the awareness among the citizens towards this program is low.
There is also an attitude of trying to get benefits even if there is no need after joining the insurance. This has increased the pressure on the fund. Similarly, in many hospital pharmacies, patients do not even get medicines prescribed by doctors. On the other hand, hospitals affiliated with insurance programs make questionable payment claims. Such a claim has not been substantiated. In the current financial year, the amount claimed by the service provider has not been settled. As a result, fair payment has also been stopped.
The need now is to increase the utility and attractiveness of the health insurance program. Participation increases only when the insured can ensure access to services. For that, the government should be able to implement alternative measures to strengthen the fund. Although the Ministry of Health and Population has prepared to introduce an integrated insurance system, it is challenging. Half a dozen government programs that cost about 28 billion 50 million rupees annually are still being implemented in their own way.
The preparation of the Ministry of Health to bring together programs such as treatment of eight types of complex diseases, health insurance subsidy, mother protection program, free treatment for the poor, helpless and disabled, heart treatment for children under 15 years old and treatment for those over 70 years old, dialysis, paralysis and cancer treatment are given in one place. If this preparation is to be concluded, the pressure on the funds will also be reduced, the scattered programs will also be organized. There are other aspects of
that need to be improved. As such, the political leadership on the board is not committed to reform despite criticism of political interference. It should be monitored whether the health institutions that have contracted with the board to operate the insurance program have provided full services or not. Action should be taken if it is not given. Those who submit false details and claim overpayment should also be punished.
On the other hand, dues should not be withheld as per rules. Citizens should also give up the mentality of having to take unnecessary services. The current 'Refer' system has added to the hassle of citizens. It should be facilitated. As the insurance program becomes systematic and effective, it can be gradually made mandatory. The success of this program can only be ensured if the trust is developed that the insurance minimizes the financial risk that the citizens bear mainly for health treatment, quality health care is ensured and the service is easily available.
