Citizens are losing trust in the state. Therefore, creative solutions must be found immediately to increase trust in this program. For that, the government's initiative and intervention are necessary.
What you should know
Insurance is an effective program to connect all citizens to access health services. Insurance programs are operated on the general premise that citizens pay a minimum fee, which strengthens the fund, and if citizens who are connected to the insurance fall ill, the same fund money is spent.
Since not all citizens covered by insurance fall ill and not all the funds are spent, such programs are expected to become stronger and more effective. On the other hand, this program also reduces the situation of citizens who have to bear financial risks, sell their homes and farms and be pushed into poverty as soon as they fall ill.
Such an effective program, which has been practiced in many countries of the world, has been considered successful and has benefited citizens, has failed in Nepal. Even large hospitals have started withdrawing from this program. Government intervention is indispensable to improve the weaknesses seen in the health insurance program and operate it effectively.
The health insurance program in Nepal was started as a pilot project in three districts in 2072. It has been managed and operated by the Health Insurance Board. Currently, the effectiveness of the program, which has been expanded to 77 districts, is decreasing. Criticism is increasing. The shortcomings of all parties associated with this program are making the program a failure.
First, the mentality that people connected to insurance should take services whether they need it or not has become strong. There was a tendency to recover the premium by any means. This increased the pressure on the fund. Second, the expensive medicines prescribed by the doctor were not available in the pharmacies of the same hospital. When citizens had to buy them from outside, their investment increased, but their trust in the insurance program decreased. The insured stopped renewing when they did not receive the service even after paying the fee. There is data that renewals are decreasing every fiscal year.
Third, many hospitals associated with health insurance have also claimed money in suspicious ways. Examples of powerful hospitals, especially those with political and administrative access and influential managers, making fake bills and taking payments have been exposed in the past. Fourth, the Health Insurance Board has not been able to manage efficiently.
It is not able to strike a balance between the claims made by hospitals and the payments made to them. The Health Insurance Board also does not have a mechanism to address, resolve and resolve disputes. It has not been able to do any constructive work to make the insurance program attractive and effective. Due to its incompetence, the general public has become a victim. Fifth, the government has made a good policy. However, resource allocation and mobilization have not been effective. This program will be meaningful only if all the weaknesses in all aspects can be improved.
Health insurance is needed. Because, the state cannot bear all the costs for the treatment of all patients. Such a system is not right. Similarly, not all citizens can bear their own treatment expenses. There is data that approximately 600,000 Nepalis are pushed below the poverty line in Nepal every year due to personal expenses for medical treatment.
This shows that treatment costs are expensive in Nepal and have become a cause of financial risk for the general public. If no state program is operated in health services, only financially capable families will be able to afford treatment. Therefore, a health insurance program is needed to reduce the state's liability and ensure that the economically weak also receive treatment. Its effectiveness is needed. This is very necessary.
Due to quality health services and affordable treatment fees, the Teaching Hospital under Tribhuvan University has stated that all health insurance treatment services will be discontinued effective from 1st Magh. This program has been operating in this hospital since 2077. However, as the number of patients seeking treatment through insurance increased, about 50 million rupees were spent monthly. However, the hospital says that only 50 percent of the claims made for payment are approved by the board and 40 million rupees are yet to be paid.
The program was closed saying that it could not be operated after incurring a monthly loss of 20 million rupees. Many hospitals have faced a similar situation and have withdrawn from the insurance program. A reliable mechanism and method are needed to resolve disputes. Which has not been adopted. Due to which all parties have expressed their displeasure with the insurance program itself.
The teaching hospital is just a reference. It cannot be said that other hospitals will not follow its style. At that time, the entire program will go into a crash. In such a situation, lower class citizens will be affected. They will be deprived of receiving health services. The failure of a necessary and successful program in many countries in Nepal is not the fault of the program, but the weakness of our organs that operate it. When a good program fails, it weakens the capacity and credibility of the state.
Citizens lose trust in the state. Therefore, creative measures should be sought immediately to increase trust in this program. For that, the government's initiative and intervention are necessary. Plans such as integrating scattered programs with insurance and subsidies, expanding the scope of diseases covered by insurance, and increasing premium fees have already been discussed. Their implementation is necessary. Key point: The mobilization of the fund should be fair, transparent, and systematic.
