There is a need for stringent monitoring against practices such as providing fake medical bills and the like with connivance of the pharmacies
Health insurance has now been made compulsory for all. Towards this end, the Health Insurance Act requires that every Nepali citizen is insured. As per the Act, all parents and guardians should insure the health of their newborn and children. Senior citizens and those with various disabilities are also required to be insured. The health insurance would also cover those in old age homes and orphanages. Civil servants visiting foreign countries and others migrating abroad for employment would also be required to have their health insured. Private organizations set up under the prevailing laws are also bound to see to it to that their employees are covered with the health insurance scheme. There would be a Health Insurance Fund to finance this progamme.
Service providers have to reach an agreement with the Health Insurance Board if they are willing to join this programme. Once the agreement is signed the concerned could provide service to the insured. The Board pays the medical bill to the health institutions on case by case basis. The premium or the contribution amounts are determined by the annual income of the insured. This would mean that the impoverished and economically deprived could be allowed a special concession for the insurance premium. Health insurance scheme for all is something new for Nepal. It is the duty of the government and concerned to see to it that nobody is deprived of his or her right to receive medical treatment. The programme would provide the insured with services such as yoga, psycho-social counseling, vaccination, family planning, safe motherhood, OPD and emergency health services when needed. The programme also would cover surgery, medicines, some of which are provided for free, and preventive services and also ambulance services, among others. However, like in most other countries, the insurance does not cover gadgets like hearing aid, spectacles, plastic surgery and also artificial reproduction services. The health institutions are required to provide quality treatment. They would receive flak if they failed to deliver such services. As per the new Act the earring health institution would have to pay a fine up to Rs. 25,000 and pay a compensation equivalent.
As such, the new health insurance programme which seeks to provide health service for all should receive a boost. There should be arrangements to provide information to all the people that such services are available and to also participate in the programme enthusiastically. There is also a need to recognize that the insurance scheme is not transferable. If efforts to check the fraudulent activities fail then the programme would suffer. Therefore, there is a need for accountability from the local level itself which would be in the interest of the people at large. Now, it is time to see how the health insurance programme moves ahead. Given the resolve it is perfectly likely that the scheme will work as in other countries. There is a need for stringent monitoring against practices such as providing fake medical bills and the like with the connivance of the pharmacies. At present, many government officials are found to be misusing the fund to purchase the medicines by providing false bills.
Shortage of drugs
Many hilly districts, particularly the mid-and far-western regions, face acute shortage of essential drugs to be supplied by the government free of charge. The government supplies 77 types of life saving drugs to the people. But their short supplies hit hard the patients who need them the most. A report from the impoverished Jajarkot district states that patients have been hit hard due to shortage of life saving drugs distributed by the district hospitals and health centres.
Delay in releasing the budget hampers the purchase and distribution of the free medicines which are useful for saving lives of children and pregnant women. As a result of crunch in the supplies of drugs the local people are compelled to buy them from private clinics or hospitals paying high prices. The government had decided to provide essential medicines free of cost so that poor families in remote areas can avail of those medicines. The budget for the health sector is now released through municipalities which have delayed in releasing the fund. The municipalities must act promptly to ensure that the essential drugs are always available in hospitals.
A version of this article appears in print on November 06, 2017 of The Himalayan Times.