A committee at the Health Ministry has recently approved a draft of National Health Insurance Policy 2013, which aims at providing universal health coverage to Nepali citizens. The proposed Insurance Policy will collect Rs. 2,000 per year as premium from every family, and provide coverage worth Rs. 50,000 in return. In other words, treatment worth Rs. 50,000 will be provided on a cash free basis to any member of a family that has paid the premium. [break]
The same coverage will be provided free of cost to families that are not able to afford the premium. Providing basic health facilities to its citizens is one of the major responsibilities of a democratic state, and the initiative of health insurance for all citizens is a step in the right direction.
However, it has to be kept in mind that though a universal health policy increases the access of most people to health services, it does not necessarily ensure universal access. The failures of previous government policies to avail free health care to all citizens provide plenty of lessons. Most regional health centers carry only the most basic medicines and equipments, and any illness that requires more sophisticated medicines or procedures cannot be treated at these centers.
Also, medical professionals at regional centers are known to attend their office only sporadically. Universal health coverage is not going to make a difference if regional health centers continue to be ill financed and poorly monitored. Also, a nagging problem of public services in Nepal is that the section of the populace that needs the services the most might be completely unaware of free service provisions, and moreover, that it is their right to demand services from public institutions.
The health insurance policy, therefore, needs to have an awareness component, making people aware about the available facilities. Also, unlike in many developed nations, in Nepal the practice has been to demand payment upfront even for emergency services. The policy needs to spell out clearly the terms for emergency health care for its clients in all health institutions. Finally, the policy provides for payment of services at “listed health facilities.” In Nepal, paying for the service is often not enough because in remote areas, there may not be a listed health facility near enough for the patient to access. To improve the public’s access to health services, it is also important to have more regional centers or cover the cost of transportation to the nearest health facility.
The policy aims to keep a record of the premiums paid through electronic identity cards. At the moment when no other government issued identity cards like citizenship certificates, driver’s licenses, or voter registration cards are electronic, the Health Insurance Policy seems to be ambitious in its scope. We hope that the policy will fulfill this and other ambitions that it has listed out, ensuring that no person is denied health services because they cannot afford it, and that the Ministry of Health will take initiatives to correct all problematic aspects of public health care and eventually provide comprehensive health care to all citizens.
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