Poor State of Health Insurance Program in Karnali and Province 2

Kathmandu: The implementation of health insurance services, which the government has implemented as an ambitious social security program, is still weak. The health insurance program, implemented from 25 Chaitra 2072 has covered only about 16 percent of the total population.

Although the population enrolling under the health insurance program has reached 16 percent, the number of direct beneficiaries is comparatively small. According to the Health Insurance Board’s online information board, 48.97 million people have so far enrolled under the health insurance program.

The allegation that the state of implementation of the health insurance program is very weak has been endorsed by the fact that not only Karnali, which is 585 km away from Kathmandu, but also Province 2, which is merely 225 km away, has an average of one lakh enrollment in total. The number of insured  in Karnali is 80,127 and Province 2 is to 180,000. These numbers are even lower than the number of insured in Kavre district of Bagmati province.

Under the health insurance program, the government has a provision to reimburse up to Rs. 100,000 per annum for medical expenses. Although this program has been implemented targeting low income and poor families, due to lack of manpower and infrastructure required for the health service delivery in health institutions, regular availability of prescribed medicines, the expected participation has not been achieved.

Consumers are complaining that most of the hospitals are giving priority to other patients over health insurance due to late receipt of payment from the Health Insurance Board(HIB).

On the other hand, the service recipients have not been able to get satisfactory service easily even though the government has been slow to recover the claim amount due to the health institutions affiliated to the board for providing services under health insurance. Most of the insured have complained that they have to go through a lot of trouble to get the benefits under health insurance.

According to the board, claims have been paid 111.79 million times so far.

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