No state can provide all healthcare to its citizens for free. On the other hand, citizens cannot afford to pay for all medical expenses themselves.

Both arguments that the state should provide all health services free of charge or that citizens should bear all the expenses themselves are impractical and impossible. The middle-ground and practical option for that is the health insurance program. In Nepal, the health insurance program, which has been implemented in 77 districts, is on the verge of failure.

If the government, political parties, hospitals, and citizens do not exercise discretion and find a safe solution, a good and citizen-friendly program will fail. The impact will be on those citizens, for whom health care has always been a huge financial burden. The negative situation created by this will increase the pressure on the state itself. The parties are currently busy writing manifestos for the elections. They should put forward practical policies for the effectiveness and continuity of the health insurance program.

The insurance program, which has been managed and operated by the Health Insurance Board, was started by the government in Chaitra 2072 from Ilam, Baglung, and Kailali. It was gradually expanded and extended to all 77 districts in 2079. 9874415 people are affiliated with the insurance program. This number is 33 percent of the total population. However, only 5927836 people are actively insured. 1095 thousand households affiliated with the insurance pay an annual premium of 3500. 1617 thousand 85 households are from the target group, they are affiliated with free insurance.

This program had greatly benefited people from the poor community. It is estimated that about 600,000 Nepalis are pushed below the poverty line every year in Nepal due to personal expenses for medical treatment. Health insurance has also reduced the financial pressure on poor families comparatively.

This program had benefited the people of the poor community a lot. It is estimated that about 600,000 Nepalis are pushed below the poverty line every year in Nepal due to personal expenses for medical treatment. Health insurance had also reduced the financial pressure on poor families comparatively. Health insurance programs have been successful in many countries of the world. Its relevance and usefulness have been confirmed. However, in Nepal, it seems to have failed due to the weaknesses of all parties related to insurance. First, after joining the insurance program, the belief that services should be taken even if they are needed or not became strong. Second, the insured could not get relatively expensive medicines from the pharmacy of the hospital concerned. Third, some hospitals claimed suspiciously high amounts. Many hospitals could not even get their legitimate claims paid.

Therefore, the Health Insurance Board is currently paying about 14 billion rupees for treatment under the insurance to 510 hospitals. Fourth, the Health Insurance Board did not have efficient management capacity. Due to the weaknesses of various parties, the effectiveness of the insurance program decreased. As a result, large government hospitals withdrew from the insurance program and the insured were also dissatisfied.

Any insurance program is successful only when the number of insured is high and the number of insurance claimants is low. But in our country, a common program for all citizens could not be created. Even those with regular income were not included in it. As a result, the amount collected from the insured has become such that it is impossible to operate the program and pay claims with the money collected from the insured. Although the government used to provide subsidies to the Health Insurance Board. Even now, the issue of subsidies is being debated after the insurance program is in crisis.

Health Minister Dr. Sudha Sharma herself has said, ‘If there is no immediate budget of Rs 14 billion, the health insurance program will be closed, and if the Finance Ministry cannot provide funds, then permission should be given to close the program.’ In times of crisis, the government’s occasional provision of subsidies cannot be considered unfair. However, no insurance program can be run without receiving subsidies from the government. Therefore, it is necessary to find alternative and long-term solutions.

The Constitution places the right to health under the fundamental right and states that ‘every citizen shall have the right to receive basic health services free of charge from the state.’ It is difficult to implement the fundamental right mentioned in the Constitution with a regular system of health care.

The health insurance program makes that possible. Since this program is in crisis, political parties that are in the race to lead the government after the elections are looking for a special role. Mainly, political parties should be able to find creative ways to increase the security and effectiveness of the health insurance program in their election manifestos.

It is not wrong for parties to show the faces of leaders and portray them as future prime ministers. However, along with the faces of the future prime ministers, health-related policies and programs that will benefit the people should also be made public. Not only theoretical, but also practical and objective policies and programs can win the hearts of the people. They can save the burden of elections.