KATHMANDU, Aug 7: The Ministry of Health and Population has prepared the first draft of its universal health insurance policy, which aims at providing healthcare services for all families at an affordable cost.
Successful implementation of the policy, which will be the first of its kind in the country, will not only increase people´s access to healthcare services, but also reduce the burden posed by often huge healthcare bills, which tend to put a strain on spending on education, good nutrition and other kinds of consumption.
“Although the government has been spending millions every year to provide free treatment for various maladies, this subsidy approch has not been effective as it does not incorporate treatment for new kinds of disease. This is pushing up healthcare spending, which in turn is pushing well-off families to the verge of poverty while compelling the poor to remain incapacitated on their deathbeds,” says the proposed National Health Insurance Policy 2012, a copy of which has been obtained by Republica.
- Premium of Rs 2,000 per family
- Service free of cost for poor, targeted groups
- Provides coverage of up to Rs 50,000 per year
- Service can be availed from state-approved hospitals
- National Health Insurance Fund to operate the scheme
To address this critical problem which is punching a hole in many pockets, the government is planning to roll out pilot schemes in selected areas on a voluntary basis within this fiscal year, an official of the health ministry told Republica on condition of anonymity. “The program would be extended throughout the country within five years of its launch, when enrolment in the scheme will be made mandatory for every family.”
The scheme, according to the draft policy, is open to every family upon depositing a premium of Rs 2,000. “This rate is preliminary; gradually the premium amount would be collected on equity basis,” the draft policy says.
Once the amount is paid, healthcare coverage for up to Rs 50,000 per year per family will be guaranteed. This means every family that makes an annual payment of Rs 2,000 would be entitled to healthcare services worth Rs 50,000 during the year.
But targeted groups and people living below the poverty line would be exempt from the service charge, the draft policy says. “Besides, healthcare services that are currently being offered for free will continue to remain free,” the policy further says.
The draft policy says policyholders can avail of services from all state-approved government, non-government, community and private health service providers throughout the country. “Payments would be made to the service providers on the basis of mutual agreement,” the draft says.
To effectively operate the program, the draft proposes formation of an autonomous National Health Insurance Fund, which will be affiliated to the health ministry. The Fund, which will also work as an Insurance Pool, will, among other things, mobilize and allocate resources, develop healthcare packages and claims settlement mechanisms, rope in service providers, monitor implementation of schemes and settle disputes. The Fund will oversee different insurance units created at the district, municipality and village development committee levels.