•      Sat Jul 13 2024

Health insurance patients to bear 10% now

Dr Guna Raj Lohani

Chitwan, Dec 18: The patients of buying government’s health insurance policies have to share the cost of the medical expenses. A senior official at the Health Insurance Board, a government entity, has informed that the Board will launch a new arrangement to this effect from the Magh 1, 2080 BS.

According to the Board Chairman, Dr. Gunaraj Lohani, co-payment is being introduced in all the hospitals where insurance policies have been accepted. This arrangement will be applicable in all government, community and private hospitals. Dr Lohoni said, “It reduces the financial burden on the state.” According to him, when all the health insurance covers, there were complaints of unnecessary tests were carried out.

Insurers have been putting pressure on doctors for various tests even if they are not necessary, saying that a large insurance amount to be paid to hospital is still outstanding. It is also expected that the pressure will decrease with the implementation of co-payment system. With the introduction of co-payment, private hospitals are also being included in the insurance scheme as per the requirement. He said, “We will decide to provide private and community services after looking at where more services are needed.”

There is a crowd in the hospital when medicines are given to insurance patients only for one month. Patients have also suffered.

Dr. Lohani informed that it has been arranged to give medicines for diseases such as high blood pressure, diabetes, cholesterol, and asthma, which should be taken regularly for three months. This arrangement will be implemented from Magh 1, 2080 BS.

At present, the hospital has been reporting that it is having a problem in not receiving payment for months even after providing insurance services. Dr. Lohani said that homework has been started so that payment will be made within one month after the claim. He said, “Payment should be given after rendering the service, and there is a provision to receive payment within one month.”

According to him, about 3 million families in Nepal are connected to Board’s health insurance policy. This program, which was started in the year 2072 BS as social health security, is currently being operated by the Health Insurance Board. The Health Insurance Act, 2074 BS has been issued and the Health Insurance Regulations 2075 BS have also been passed and implemented.

Know about HIB

Health Insurance Board (HIB) is a social protection program of the Government of Nepal that aims to enable its citizens to access quality health care services without placing a financial burden on them. The households, communities and government are directly involved in this program. Health Insurance program helps prevent people from falling into poverty due to health care costs i.e. catastrophic expenditure due to accidents or disease by combining prepayment and risk pooling with mutual support. This program also advocates towards quality health services. This program attempts to address barriers in health service utilization and ensure equity and access of poor and disadvantaged groups as a means to achieve Universal Health Coverage.

Out-of-pocket expenditure has always been the largest source of funding in Nepal, followed by government expenditure. For years different studies, assessments, reviews of the sector called for interventions to reduce OOP as it is the most unfair/regressive way of funding health services.


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