Board's Initiative Towards Health Insurance Program Reform: Preparing to Reduce Unnecessary Expenses and Increase Revenue

Nepal Health News, Kathmandu: The Health Insurance Board has made several decisions aimed at making the insurance program more effective by reducing unnecessary expenses and increasing revenue.

A recent meeting chaired by Board President Chandrabahadur Thapa concluded that unnecessary tests and duplicate claims have caused issues with reimbursements. As a result, the board has requested the Ministry of Health and Population to ensure treatment is provided according to established protocols.

According to the Board, there is currently duplication in services as even the government's basic healthcare expenses are covered under the insurance program. A recommendation has been sent to the ministry to resolve this issue.

Ministry’s Prompt Action: Suggestion Task Force Formed

Following the board’s request, Health and Population Minister Pradeep Paudel has already formed a task force to implement healthcare standards and eliminate duplication.

Executive Director Dr. Raghuraj Kafle stated that if all government-supported treatment programs are operated through the Health Insurance Fund, duplication will be eliminated and costs will also decrease.

New Revenue-Boosting Measures Proposed

To strengthen the financial base of the Insurance Fund, the board has proposed mobilizing several new revenue sources:

• Requiring pharmaceutical companies to contribute a fixed portion of their expenses to the Insurance Fund.

• Requesting government approval to launch a Health Insurance Lottery.

• Arranging for a direct share of revenues from medical supplies, recharge cards, digital banking, alcohol, sugar-based products, and petroleum to go to the Insurance Fund.

Move Towards Integrated Health Insurance System

Kafle stated that integrating the “Directive on Treatment Fund for Impoverished Citizens 2080” and the “Mother and Newborn Child Safety Program 2078” with the Health Insurance system would enhance service delivery. A proposal has been submitted to the ministry to make insurance enrollment mandatory for targeted groups.

Previously, Minister Paudel had already made the decision to allocate one percent of income from Federal Hospital Development Committees to the Insurance Fund.