The latest draft - prepared by a committee comprising representatives of the National Planning Commission (NPC), the Prime Minister´s Office (PMO), the Ministry of Finance (MoF), the Ministry of General Administration (MoGA), the Ministry of Health and Population (MoHP), the Ministry of Labor and Employment (MoLE), the Insurance Board and the World Health Organization - is entirely different from the first one prepared by a technical committee in August last year.[break]
“It (the draft policy) will now be tabled at the health ministry and then forwarded to the Cabinet for final approval,” Kavi Raj Khanal, an under secretary at the health ministry, told Republica.
The main objective of the policy, according to the draft, is to ensure universal health coverage by increasing access to necessary and quality health services so that individuals´ ´out-of-pocket expenditure´ on healthcare goes down.
For this, the government intends to raise certain premium amount from every household every year. After this healthcare services will be provided on a cash-free basis after electronic identity cards issued at the time of enrolment is shown, the draft policy says.
Although the previous draft policy had coined the idea of providing healthcare coverage of up to Rs 50,000 per year per family by collecting annual premium of Rs 2,000 per household, the latest draft remains silent on these matters. It only says: “The benefit package shall include healthcare services and other benefits, as prescribed and a ceiling may be applied to the services in benefit packages.”
But funds will be provided by the government to ensure enrolment of poor and target households in the insurance program, the draft says. “And arrangements will be made for insured household members to access defined healthcare services from listed health facilities.”
“Further details on the scheme, along with premium and coverage amount, would be published in the guideline of the National Health Insurance Program,” Khanal said.
The government is planning to introduce the insurance program by enacting a separate Act and the health ministry will initiate the implementation of the program.
“The health insurance program will integrate existing social health protection interventions and programs into the insurance program and develop a national framework to integrate government supported health insurance initiatives,” says the draft policy. “Healthcare services that are not covered by this program will continue to be provided by the health ministry.”
To operate this program, the draft has envisaged formation of an autonomous entity called the National Health Insurance Fund. This fund will be government by a board comprising representatives of the NPC, leading ministries, non-government and professional organizations and consumers.
The main responsibility of the fund would be to pool funds and sign contracts with health service providers. “The fund may contract NGOs, cooperatives and private insurance companies to undertake specific works,” the draft says.
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