The Constitution has guaranteed citizens’ right to health. In a country with a democratic system of governance like ours, ordinary citizens must be ensured access, particularly to the rights to education and health. When these two rights are secured, people’s lives become easier. To ensure the right to health, the general public must be connected to health insurance. In recent years, the government has actively implemented the health insurance programme. By bringing many people under insurance coverage, it has made access to treatment easier. Even citizens with little or no income are able to receive certain treatments designated by the state through this scheme. However, the decision made by the Health Insurance Board on January 8 to provide outpatient health services worth only Rs 25,000 per family per year has not been considered reasonable. This means that in a family of five members, services worth only Rs 5,000 per person would be available. The provision, which will come into effect from February 13, is likely to place an additional burden on the general public. Not everyone falls ill at the same time, nor does everyone seek treatment simultaneously. Even so, when treatment is required, Rs 25,000 is insufficient. In such circumstances, the limit set for outpatient services is inappropriate. Apart from outpatient services, under the current system, insurance coverage of Rs 200,000 per person is available for eight types of critical illnesses. The Board has introduced the new arrangement after revising service fees, stating that it aims to reduce financial pressure on the Board and ensure more effective utilisation by insured individuals. Patients will be able to spend up to Rs 75,000 for additional services when admitted to hospital wards.
Int'l Universal Health Coverage Day being marked today
It has been stated that the current arrangement has been introduced to manage financial challenges. The provision is expected to remain in place until the insurance fund increases. The public has also been urged to reduce unnecessary health check-ups. In recent times, the burden of payments on the insurance fund has increased, and some hospitals have even stopped providing insurance-based services. The current arrangement introduced by the Board goes against previous agreements. Changing the provision that allowed insured individuals to receive services worth up to Rs 100,000 per year, regardless of the type of service taken, is not a positive step in itself. This increases the risk of discouraging existing insured members from using services and may even push them to drop out of the programme. The current arrangement is likely to adversely affect people suffering from chronic illnesses. The very purpose of the insurance programme is to ensure access to health services for low-income or income-less citizens. In line with the concept of a welfare state, the insurance system was designed to enable people to receive such services. Before reducing outpatient services, there appears to have been little consideration of what alternatives would be available to the public. The insurance programme was introduced precisely because marginalised citizens were unable to access services. Moreover, healthcare in our country is already expensive. For ordinary citizens, the insurance programme is the only means of obtaining appropriate health services.
It is impossible to determine in advance when any individual may require healthcare. For those with sufficient financial capacity, seeking health services is not a major issue. For citizens with weak economic conditions, however, it is a difficult task. This is precisely why the insurance programme was implemented. Outpatient services cannot be adequately accessed with a limit of only Rs 25,000. For some people suffering from chronic diseases, outpatient services alone are insufficient. For those who require repeated treatment, this limit becomes burdensome. Even for citizens who need inpatient treatment, the allocated amount is inadequate. Insurance coverage must be sufficient to meet the needs of the general public. Health insurance services in Nepal were achieved only after prolonged effort. In the past, people with access were able to receive benefits through other state resources. However, for ordinary citizens, the state’s provision of treatment through an insurance system is, in itself, an excellent solution. Benefits can be determined based on individuals’ economic status, and insurance premiums can be adjusted accordingly. However, at some point in life, everyone may lack a regular income. This is particularly true for senior citizens, whose capacity to access such services is limited. Therefore, the state must play a role in ensuring they are not deprived of services. While the state can reduce expenditure in other areas, it appears necessary to reconsider this arrangement when it comes to healthcare services for the general public.
