Kathmandu: Experts and stakeholders have concluded that revisions to the current health insurance premium and package in Nepal are essential. During an interaction program, Dr. BhagawanKoirala, Dr. GunarajLohani, Dr. Sudha Sharma, and Dr. Saroj Sharma stressed the need to move beyond the existing system, where individuals pay RS 3,500 to receive treatment services worth RS 100,000.
Secretary of the Ministry of Health and Population, Dr. Bikash Devkota, expressed his agreement with this conclusion. Speaking at the interaction program organized by Binaytara Foundation USA and Swasthya Khabar Foundation, Dr. Devkota emphasized the need for discussions on premium collection and package development. He further added, ‘The new executive director and the chairman should prepare accordingly. The issues raised by the panel are crucial. The premium collection pathway appears to be narrowing. Either the government should fully fund it, or alternative resources should be sought. Therefore, discussions on premium collection are necessary, and I support the development of new packages. Options such as RS 3,500, RS 5,000, and RS 10,000 packages should be introduced, covering OPD, surgical, and other services.’
Former Chairperson of the Health Insurance Board, Dr. GunarajLohani, emphasized that to sustain the current health insurance model, the premium should be at least RS 8,000. He stated, ‘If people pay RS 3,500, the government should contribute RS 4,500. Only then, the existing package can function. Otherwise, how will the Health Insurance Board secure funds?’
Dr. BhagawanKoirala, a member of the Health Insurance Reform Taskforce, pointed out that the government bears 70% of the insurance cost, creating significant financial challenges. He remarked, ‘New initiatives often face difficulties, and we are encountering more challenges than anticipated. However, health insurance is necessary and has been a positive step. It needs corrections, and policy-level discussions and commitments are crucial.’
Former Health Secretary Dr. Sudha Sharma noted that health insurance has not been functioning as expected and highlighted the need for various improvements. She emphasized that not only the premium and package but also existing operational flaws should be addressed. She stated, ‘We have been prioritizing discussions only on health insurance expenses. However, the issue of why insurance has not been successful is merely a symptom.’
Dr. Saroj Sharma, former Acting Executive Director of the Health Insurance Board and Head of the Quality Standards and Regulation Division at the Ministry of Health, stressed the need to increase premiums for the effectiveness of health insurance. He suggested, ‘Heavy taxation on tobacco, alcoholic beverages, sugar, and similar products should be directly allocated to the health insurance fund.’
Dr. Binay Shah, Founder and Chairperson of Binaytara Foundation, stated that strengthening the Health Insurance Board is essential to reducing health inequalities and bridging gaps in service accessibility. He remarked, ‘I was pleased to see the board’s slogan, ‘Your Health, Our Commitment.’ Additionally, I found a document where the board has committed to achieving Universal Health Coverage by 2030. However, after reviewing the ‘Nepal Demographic and Health Survey 2022,’ I realized that achieving these commitments and targets poses significant challenges. That is why we initiated this policy discussion.’
Parallel Government Programs Pose Challenges
Many participants in the interaction program highlighted that the government should avoid running parallel social security programs similar to health insurance. They pointed out that multiple schemes such as health insurance, social security funds, citizen investment funds, and welfare funds for the army and police have created confusion among the public.
Dr. Lohani noted that Nepal’s health insurance program has not been implemented as per the Health Insurance Act. He emphasized that the formal sector should be mandatorily included, and premiums should be determined based on income levels. He stated, ‘Since social security and citizen investment funds are performing similar functions, duplication must be eliminated.’
Dr. Koirala emphasized that the integration of all these funds and benefits into the health insurance system is necessary for success. He explained, ‘Civil servants receive separate benefits, and the army and police have their own schemes, preventing health insurance from becoming mandatory. Additionally, the government provides distinct healthcare services for children and senior citizens. If all these programs were incorporated into health insurance, a NPR 95 billion fund could be created.’
Dr. Sharma said that since there is health insurance, there is no need for the government to run programs such as social security and the citizen investment funds. She added, ‘There is no need to run other programs that duplicate health insurance, when health insurance alone deals with transactions worth billions.
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