KATHMANDU, July 21: Forty-year-old Sunita Ghimire (name changed) from Ilam was admitted to Shahid Gangalal National Heart Centre after developing a heart condition. She underwent angioplasty to open a blocked artery, hoping her health insurance would ease the financial burden. Instead, she was disappointed to learn that the hospital provides health insurance coverage only for outpatient services, not inpatient treatment.
Too young to qualify for senior citizen benefits and too old for child health support, Ghimire was left without any financial assistance. She also found that the government's support for low income patients is available only to those requiring heart surgery.
"I have been told I will need repeated treatment. I came relying on health insurance, but it doesn't cover my hospital stay," she said.
Without an income of her own and with her husband working as a security guard, Ghimire said managing treatment costs has become a major challenge. Since her admission, the family has spent nearly Rs 100,000 on medicines, food, accommodation and travel. Before arriving in Kathmandu, they had already spent more than Rs 100,000 on treatment at a local hospital. She estimates her total medical expenses could reach Rs 400,000 to Rs 500,000.
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"With such a small income, should we raise our children or repay our loans?" she asked.
Pampa Bishwakarma of Hetauda shared a similar experience. She has been staying at the hospital since mid May while her husband undergoes treatment for heart disease. Although he received Rs 100,000 in assistance under the government's poor patient support program for heart surgery, the family has had to buy many medicines outside the hospital, adding to the financial burden.
They have already spent about Rs 300,000 during the treatment. When they returned for a follow up after three weeks, her husband's heartbeat became irregular again, requiring emergency admission. She said he also needed additional treatment after excessive bleeding from a cannula inserted in his hand while going to the toilet at night.
With treatment still ongoing, the family has borrowed another Rs 300,000. Living mainly on subsistence farming, Bishwakarma said repaying the debt has become a major concern.
Many other patient attendants at the hospital expressed similar frustrations, saying the lack of inpatient health insurance has made long term treatment unaffordable.
Hospital Information Officer Sudip Dahal acknowledged the complaints, saying patients frequently ask why inpatient services are not covered under the national health insurance scheme.
At present, the hospital offers insurance only for outpatient care, with coverage of up to Rs 25,000. While targeted programs exist for low-income patients, senior citizens, children with heart disease and a few other groups, many patients do not qualify. The hospital also has a small emergency fund providing Rs 10,000 to Rs 15,000 for extremely poor patients, but Dahal said it is insufficient.
He said insured patients should be entitled to benefits of up to Rs 100,000, but cannot access them for inpatient treatment because the government has yet to reimburse nearly Rs 400 million owed to the hospital under the health insurance program.
"The inpatient insurance program can begin only after the government clears the outstanding payments and ensures regular reimbursement," Dahal said.
