Though the federal government’s medical health insurance program has been expanded to all 77 districts of the nation, solely 20 p.c of the overall inhabitants has been lined by the scheme to this point.
The programme, which goals to make sure common entry to high quality well being care companies, was launched in mid-July 2015 from three districts—Baglung, Kailali and Ilam—as a pilot programme.
Officers on the Well being Insurance coverage Board, beneath the Ministry of Well being and Inhabitants, concede that regardless of the speedy growth of the scheme all through the nation in a brief interval, the share of the folks concerned within the scheme could be very low.
Furthermore, the dropout fee or renewal of the scheme is lower than 50 p.c.
“The variety of folks lined by the medical health insurance scheme is dismal,” mentioned Dr Damodar Basaula, government director of the Well being Insurance coverage Board. “Numerous elements are liable for the dismal participation of most of the people within the programme.”
In keeping with knowledge offered by the Board, 5,304,270 folks—or 20.3 p.c of the overall inhabitants from 1,508,514 households—have signed up for the scheme.
Of the overall individuals who registered their names for the service, 20,89,599 (39.39 p.c) have availed of companies beneath the scheme from 441 healthcare services—state-run, personal or community-designated.
The federal government itself pays the insurance coverage premium for sure groups-those dwelling under the poverty line in 26 districts, aged folks above 70, relations of individuals dwelling with HIV, disabled folks and people affected by leprosy, and multi-drug resistant tuberculosis. The federal government additionally supplies a 50 p.c low cost on the annual premium paid by the relations of feminine group well being volunteers.
Underneath the scheme, a household of as much as 5 members has to pay Rs3,500 to get therapy, together with medication, check-up and counselling. Both one member of a single household with 5 members can use the insurance coverage protection value Rs100,000 in a 12 months or the quantity will be divided amongst 5 members. Equally, a household with greater than 5 members has so as to add Rs700 per further member for medical health insurance protection of as much as Rs200,000.
Folks lined by the insurance coverage coverage can avail themselves of well being care companies from the designated healthcare services upon presenting their identification playing cards. The expense incurred by the well being services is reimbursed by the Well being Insurance coverage Board.
Specialists say dismal participation of most of the people and excessive dropout fee from this system is a matter of concern.
Lack of knowledge concerning the programme, authorities’s apathy to categorize folks dwelling under the poverty line in all districts, poor service supply on the healthcare facilities affiliated to the scheme, lack of medicines at hospital pharmacies, lack of educated well being care suppliers all year long within the well being services, and lack of kit at well being services are thought of to be among the main causes for poor public response to the scheme.
“Probabilities of dropout from the scheme will increase when folks enrolled within the scheme don’t want well being care service in a specific 12 months,” mentioned Baburam Khanal, beneath secretary of the Board. “If the insurance coverage policyholders don’t want well being care companies in a specific 12 months, they assume their cash has gone to waste.”
Folks enrolled within the scheme must pay their insurance coverage premium yearly and even when they don’t make use of the companies they don’t get any refund.
Medical doctors say it’s the duty of the authorities involved to make sure high quality well being care companies, educated human sources at well being services all year long and tackle all problems with the medical health insurance scheme to extend public participation within the scheme.
Officers mentioned that even when the scheme is categorized as ‘medical health insurance’, it’s a social safety program which goals to make sure common entry to high quality well being care companies.
“Even when everybody doesn’t want the companies, it’s a reduction for many who are in want and can’t spend Rs100,000-Rs200,000 on medical bills,” added Khanal. “We’ve got not been in a position to make folks perceive these points as a result of it’ll come in useful once we or our relations want medical therapy.”