Scheme attracts people with chronic conditions

August 06, 2018

Nayak Paudel, The Kathmandu Post, 6 Aug 2018

The government’s Health Insurance Scheme has mostly enrolled individuals suffering from chronic illness and living under medication, according to the Health Insurance Board (HIB).

The plan was introduced with an objective to provide financial relief to the people at times of emergency and encourage them to visit health facilities for regular check-ups as preventive lifestyle. However, the HIB data shows the scheme has been popular mostly among those suffering from chronic health conditions, including hypertension, abdominal and pelvic pain; and gastritis and duodenitis.

According to HIB Executive Director Dr Madan Kumar Upadhyaya, mostly people suffering from chronic diseases took up the scheme as they have to rely on regular medication, which is covered under the scheme.

Under this plan, a family of up to five members must pay a premium of Rs 2,500 annually to avail health services up to Rs50,000. A family comprising more than five members, must pay Rs425 for each additional member. This would qualify them for an additional insurance cover of Rs10,000. The maximum insurance cover is only up to Rs100,000 even for a family with more than 10 members. The limited amount of health cover discourages people to register for this plan, health experts say. The amount provided under the plan would not suffice to treat one member of the family in some cases, insurance experts argue.

This trend seems to have defeated the whole purpose of the government policy of providing a universal health service to its people. “It is very positive that people use the scheme to avail medication for their chronic conditions. But the low public participation is discouraging,” said Dr Upadhyaya.

The scheme, which was piloted in 2016-17 in three districts--Kailali, Baglung and Ilam, has since been expanded to 36 districts where about 1 million members from 215,417 families have already enrolled in the scheme. The government plans to expand the scheme to all 77 districts by the end of this fiscal.

The HIB data shows Rs560 million as premium inflows and Rs518 million outflows to settle treatment claims. The government also pays the premium for the poor families.

Health insurance: Top 5 Diseases

Diseases                                       Number of beneficiaries

Unspecified infectious disease        19,376

Essential Primary Hypertension      18,977

Abdominal and pelvic pain              14,579

Routine General Health Check-up   10,033

Gastritis and duodenitis                   7,750

Source: Health Insurance Board