During his first term as US President, Barack Obama spent considerable political capital in pushing a universal healthcare scheme through the obstreperous American legislature. The much-awaited piece of legislation was mainly aimed at covering up to 30 million Americans denied health coverage under the existing schemes. The US has long been criticized for having one of the shoddiest healthcare systems in the developed world, with sky-high expenses and dismal coverage. In contrast, Scandinavian countries offer top-class free health services to all their citizens, so do the likes of France and Spain in mainland Europe. Third-world countries like Nepal are only just taking baby steps towards quality universal coverage. Towards this end, the government has unveiled its twin universal healthcare schemes, one under the Social Security Fund (SSF) and the other under the Ministry of Health and Population.
The Health Ministry’s draft policy on National Health Insurance seeks universal health coverage by expanding access to quality and affordable care. For this, the government intends to raise a certain premium from every household and provide healthcare services on cash-free basis. The services will be provided without any premium for those below the poverty line. The new health plan will bring great relief to those uncovered under current programs, which fail to incorporate new diseases.
Likewise, the SSF scheme would enormously benefit informal and formal sector workers, many of whom lose their entire life saving when they or their loved ones fall sick. To deal with this problem, the government introduced the concept of social security in July 2010 which envisaged formation of a social security fund to develop social security schemes for workers based on their contributions. Since then, the SSF has been collecting one percent social security tax from the non-taxable basic salaries of workers in the formal sector. The SSF intends to make it mandatory for employees and employers to contribute 10 percent of the workers’ basic salary, to be topped up by another 10 percent from the government coffers.
The two schemes could benefit millions of poor Nepalis deprived of vital healthcare services. But there are hurdles ahead that could hinder progress. The first of those is the risk of duplication, whereby a worker in formal sector might claim benefits from both the universal as well as the SSF schemes. The government plans to prevent such duplication through the distribution of biometric smart cards, the first of which are expected by mid-2014. A related problem is that since the biometric cards will be based on voter list provided by the Election Commission, it will leave children uncovered. Moreover, the absence of a legislature means that there is no Act to implement these schemes.
The thousands who have contributed to SSF funds are already questioning the rationale of their investment which has been without returns so far. There is a strong case for getting the desired Act through an ordinance since it might be some time yet before the country has an elected legislature. Given the political will, there is no reason Nepal cannot have a top-notch universal health coverage. Unlike in the US where the Republicans have time and again hindered vital healthcare reform, Nepali parties across the political spectrum are one on the indispensability of an inclusive healthcare scheme.
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