KATHMANDU, Jan 8: The Ministry of Health and Population (MoHP) recently formed a Health Insurance Reform Committee to improve health insurance and enhance citizens' access to healthcare services. The committee has submitted its report, sparking growing interest in how it will address the issues in health insurance.
The Health Insurance Reform Committee submitted its report to Health and Population Minister Pradip Paudel on January 1. Minister Paudel stated that the ministry is preparing to present the report to the Cabinet. Although the committee submitted the report a week ago, it has not yet been made public.
Dr Raghu Kafle, a member of the Health Insurance Reform Committee, recently shared that the committee has suggested making health insurance mandatory for everyone and expanding the coverage of the existing insurance. "The main thing is that we have made theoretical improvements," Dr Kafle said.
TUTH will continue to provide health insurance coverage
Dr Kafle stated that until now, the health insurance system has excluded the majority of citizens who should be covered, while only groups such as people with disabilities, senior citizens, the extremely poor, the helpless, and those unable to pay have been included. He added that the theoretical goal moving forward is to enroll 100 percent of citizens in health insurance.
He said that the policy recommendation report suggests making groups not currently covered by health insurance, such as traders, entrepreneurs, leaders, teachers, employees, formal sector workers, and elected representatives, mandatory participants.
Including these groups will also introduce a progressive fee payment system. He argues that this system can increase the capital of the insurance by collecting additional amounts from those already covered. The report also proposes a co-payment system for insurance. Since most countries worldwide have a co-payment system in their health insurance, he suggests that Nepal should adopt the same system.
The system will require those who contribute more to make a higher contribution to the insurance fund. While the treatment will remain the same for everyone, those who contribute more may receive treatment in different hospitals or facilities. "The quality of treatment will remain the same, but those who contribute more will need to use a cabin or private hospital if they choose," he said.
The latest insurance system will increase coverage from Rs 100,000 to Rs 500,000. It will also provide basic health services free of charge. Dr Kafle stated that the report recommends making structural changes to the current insurance board and implementing legal reforms. It also suggests managing the necessary human resources to implement the insurance.
Dr Kafle said the report proposes integrating and implementing various social security programs, such as free health services and the treatment fund for poor citizens, which are currently scattered. He also mentioned that the report suggests including private hospitals that meet the required standards in the implementation of this insurance.
