The federal, provincial and local level governments are required to bear insurance premium of poor and marginalized families
The Legislature-Parliament Tuesday passed the much-awaited Health Insurance Bill, ensuring all citizens will have their health ensured and get basic health services from government-run hospitals and private ones. The bill will come into force once it is authenticated by the president. The bill was passed by Parliament after the government ran a pilot project in eight districts where people were found to be enthusiastic about the health services through an insurance policy. The Ministry of Health will come out with detailed guidelines about the ways of its operation and will also fix the premium that an individual or a family is required for insurance from a registered insurance company. In order to plug the loopholes and avoid unnecessary bureaucratic hassles an individual may face in an insurance company to lay claim on the expenses incurred while undergoing medical treatment, the bill has specifically stated that the concerned hospital which provided health services to a patient will claim such expenses with the insurance company. It means that a patient does not need to knock on the door of a health insurance company with claims for health services s/he received from a hospital.
The bill states that those who have bought health insurance policy will get services like yoga, immunization, family planning, safe motherhood, out-and in-patient care surgery, medicines, emergency care, curative services, rehabilitation, ambulance (except for air ambulance) and health services as specified by the health insurance guideline. Initially the bill will be applicable to all civil servants and their families, migrant workers and their families and the people working in private and organized sectors and their families. This bill will be expanded to include even people not working in organized sectors. It also states that the federal, provincial and local level governments are required to bear insurance premium of poor and marginalized families as defined by other laws. The rehabilitation centres, orphanages, old-age home and correction centres will also have to enroll the disabled, orphans and elderly people residing in their shelters in the health policy.
The community and government-run hospitals will get preference to provide such services and people will also get services from private, cooperative and hospitals run by donor agencies, not exceeding the limit of health insurance. The government and parliament deserve special appreciation for bringing out the health insurance bill. Once it comes into force, it is expected that the community and government hospitals will become more accountable to the people with quality health services. But bringing out the health bill is not enough. Efficiency of all public hospitals has to be enhanced and local level governments need to monitor them regularly so that people get quality health services as per the premium paid by them. On the other hand, the government must stop bearing medical health expenses of people having access to power corridors. All elected officials from top to bottom must be made mandatory to purchase the health insurance policy so that the general people can also get inspiration to buy the policy. The bill will hugely cut expenses on healthcare of a family. But the government needs to come out with effective planning along with the provision of doctors, nurses and equipment in all hospitals.
Surgery dates at the Shahid Gangalal National Heart Centre have been booked till March of next year. This could be because the hospital provides free heart surgery to children and the elderly as well as people from marginalized communities. The hospital has eight heart surgeries who perform six surgeries each a day. However, surgeries are conducted immediately in case of emergencies. Meanwhile, people from all age groups can avail of free surgery for heart valve surgery at the hospital. This is another reason why patients have to wait for months in order to have surgeries for their heart ailments.
This fiscal a total of 1,683 heart patients have undergone heart surgery at the hospital. Of them, 251 patients have received free surgery for their heart valve. Similarly 787 children aged below 15 and 465 people more than 75 years old and 2,244 people from the marginalized communities have had the life saving heart surgeries. The hospital should have more surgeons keeping in mind the high demand for their services which is not available at most hospitals.
A version of this article appears in print on October 12, 2017 of The Himalayan Times.