Feature story: Health Insurance Programme getting more members gradually

-Kalpana Poudel

Kathmandu - Health insurance programme launched by the government one and half years ago has started getting more and more members gradually. 

In the beginning, people were in confusion about the programme launched with a new concept. The programme, launched with an objective of providing easy and smooth health services to the people, has been expanded to 15 districts and people have started showing interest in the programme. 

Director of Social Health Security Development Committee, Dr Gunaraj Lohani, said that problem was faced in the beginning to convince the people to become members of the programme.

 Various queries developed about the programme including process to get treatment service, available treatment service of the type of diseases and whether or not the insurance amount is returned if the policy-holder meets natural death have put the people in dilemma. 

He said now people have started knowing about the programme once it launched. Dr Lohani said, “It has become a little bit easier to make people aware about the health insurance programme after imparting training to chiefs of service-providing organizations, doctors and pharmacists, among others. 

The government had launched the programme one and half years ago to provide easy and smooth treatment service to the general people through Social Security Development Committee. The programme launched from Kailali district from April 7, 2016 has now 84,000 policy-owners, according to the Committee.
 
According to the Committee, there will be more than 100,000 insurance policy-owners by the end of the fiscal year 2016/17. The Committee has the record that out of 84,000 insurance policy holders, 24 per cent members or 20,000 policy holders have so far received the treatment service. 

The programme has been implemented in Kailali, Baglung, Ilam, Kaski, Palpa, Myagdi, Achham, Baitadi, Jumla, Jajarkot, Chitwan, Makawanpur, Bhaktapur, Tanahu and Gorkha districts. 

All the preparations have been completed to implement the programme in other districts including Mahottari, Bardiya, Surkhet, Jhapa, Parsa, Sindhuli, Solukhumbu, Sunsari, Rautahat and Rolpa, said Social Health Security Development Committee Officer, Jaguram Chaudhary. 

Palpa and Kaski districts are in forefront to acquire membership of the programme. More than 20,000 people have become members in Palpa while 23,000 in Kaski. 

Kailali, however, has the highest number of insurance policy holders receiving health treatment service. The insurance programme was initiated from Kailali. Out of 11,686 members in the district so far, 6101 members received the health treatment service. 

Out of the policy holders, number of woman policy holder is high as compared to men. The programme has been initiated in Bhaktapur, Gorkha, Tanahu, Chitwan, Jumla, Jajarkot and Makawanpur districts from mid-June. People, who have acquired membership in mid-June would get health treatment service from mid-August. 

The Committee has signed an agreement in order to provide health treatment services to its members only at Bir Hospital, Teaching Hospital, Manmohan Cardiothoracic Vascular and Transplant Centre, Patan Academy of Health Sciences, Gangalal Heart Centre, Maternity Hospital, Trauma Centre, Sukraraj Tropical and Infectious Disease Hospital, Teku. 

The highest number of members has received treatment service at Bir Hospital so far. Chief of Social Security Unit of Bir Hospital and focal person of the health insurance programme of Bir Hospital, Tikaram Paneru, said that more than 60 members received the service. 

People of the districts, where the programme has been implemented, can get membership of the programme for five members after paying Rs 2,500 annually. The family can get treatment service of Rs 50,000 within a year after getting the membership of the programme. 

There is the arrangement that the family having more than five members can also be members of the programme after paying additional Rs 450 for each member and can get treatment service of Rs 60,000. 

The membership is only valid for one year. The family should pay the same charge again to get the membership for next year. 

The health insurance programme provides OPD service, emergency services as well as different health tests and medicines. The member can get health-test, X-ray as well as other services. 

The health insurance programme does not incorporate plastic surgery, ear-phone and expensive glasses. The members injured in clash after consuming alcohol cannot get treatment service under the programme. 

Committee Director Lohani said that although the insurance removes possibility of a big disease, the committee does not help the issues mentioned above. 

He said, “A policy holder has to mention the name of health institutions where he/she wants to undergo check-up in course of filling up the forms of insurance programme. 

An arrangement has been made to get treatment service at central hospital through health posts, primary health centre, district hospital and regional hospital. Committee officer Rabindra Ghimire said that only the referred and emergency patient can get treatment service at the central hospital. 

In other hand, it is important to know that the family cannot get insurance amount return back if a member of the family gets natural death. The family members should mention the name of hospitals if they want to get treatment service from different hospitals. 

The Committee has already sent different medical equipments including x-ray machines, ECG in some districts, where the programme has been implemented, for the same and the medical equipments will be sent in other remaining districts soon, said Chaudhary.  (Translated by Avilasha Pokharel)