National 3 (Spotlight Weekly)

Healthy Signs

The new health minister unveils ambitious policies, including a health insurance scheme

By SANJAYA DHAKAL

Even before becoming health minister, renowned neuro-surgeon Dr. Upendra Devkota used to talk about the need to introduce health insurance to enable the poorer sections of the population afford the cost of treatment. Every time Dr. Devkota talked with the media, he used to raise the issue, stressing this was of utter importance if we were to ensure health for all.

So when fate catapulted him from the operation theater to the swiveling chair in the Health Ministry, the first thing he did was to announce 18-point new health policies and programs that unsurprisingly included the introduction of health insurance scheme.

Bir hospital : Serving the public

Health insurance, or social insurance, is an accepted practice the world over. Countries use this scheme so that even people who cannot otherwise afford the treatment would be able to do so.

"The government has announced the social health insurance system so that people do not have to stay away from treatment just because they don't have money or they can't afford the high cost," said Dr. Devkota, unveiling his new policies.

Experts and analysts agree that health insurance scheme is necessary for a country like Nepal. "I fully support this scheme. If the state has to fulfill its duties of providing health service to its citizen, this is an effective means of rendering them," said Dr. Ram Prasad Shrestha, senior surgeon and former director of the Bir Hospital.

"About 40 percent of the population lives below poverty line in the country. Moreover, only 20 percent of the population can afford the rising treatment costs. The government cannot continue providing subsidies forever. On the other hand, the private sector who invest in the health infrastructures will naturally try to realize the return. In such a situation, it is only the health insurance scheme that can provide easy answers," said Dr. Shrestha.

From east to west and from developed to developing countries, all have started or are in the process of starting some sort of social security that covers health insurance of their citizens. Some western countries do not even allow people who are not covered by such schemes to enter. "There could be different modalities, but each have the basic aim of equitable insurance sharing," said Devi Prasai, a health economist at the Ministry of Health.

According to Prasai, health insurance is basically a risk-sharing arrangement between healthy and sick people. "Just like when fire breaks out in a house in our villages all the members of the community try to help by bringing buckets of water, the health insurance means that healthy people dole out monetary help to cure sick people."

Furthermore, health insurance also makes economic sense. The costs of treatment are rising day by day, there is also a need to lure private sector to invest in modern infrastructures. "In a country where there is a functioning health insurance system, foreigners, too, will be prompted to invest in health infrastructures," said Dr. Shrestha. Besides, insurance means that there will be a stable source of resource to handle the health sector.

"The government plans to enforce the health insurance among the formal sector by the end of this fiscal year and gradually expand it to cover the central, regional, sub-regional and zonal level government hospitals," said the minister.

The government has already set up Health Economics and Financing Unit at the Ministry to look into the nitty-gritty of implementation aspects of health insurance, among others.

Initially, the government wants to include employees of the formal sector in the health insurance net. The ministry has already formed a committee to study what percentage of the payroll should be deducted for this scheme and what benefits the insured person will be entitled to. The government will also supplement the deducted amount like it does in the case of provident fund. "As this is an equitable scheme, the employees will have to bear proportionally based on their income. The employees with higher income will be liable for higher sharing and vice versa," said Prasai.

The Health Ministry has already conducted a feasibility study of the insurance scheme in the country. "We have found that for the scheme to be economically viable it has to cover at least 30,000 people," said Prasai.

"As far as scheme itself is concerned there should be no two opinions about its necessity. The only thing is how successfully it will be implemented. I hear that the ministry has already started analyzing various aspects of this scheme. Important thing is there is a person who understands and has first-hand knowledge about the health system at the helms at present. We hope he is successful," said Dr. Shrestha.

Another major point of the new policies is the government's keenness to regulate and monitor the private sector health service-providers like hospitals, nursing homes and clinics.

The policy announces that the government will classify and fix the service fee of practicing doctors of private hospitals and nursing homes based on their qualification, experience and standard of the institution they work for. "This is also a positive step. Really, there was an acute need to regulate the haphazardness that prevailed this area. Obviously, there has to be differences in the fee commanded by senior doctors with years of experience and the fresher graduates. Besides, there has to be a body to regulate all this."

The government's policy also states that it aims to discourage the prevalent practice of subjecting patients to unnecessary check-ups, over investigation (in course of diagnosis) as well as over prescription. The ministry will set up a separate cell to monitor these things. The policy also promises to make public within one and a half month the new prescription standard and anti-biotic policy. In fact it has been a long public complaint that doctors, especially in private nursing homes, engage in over investigation and over prescription.

"If a patient can be cured by simple and cheap anti-biotics, it is wrong to prescribe him/her with expensive ones. Likewise, there is also tendency among some practitioners to fill their prescription forms with a number of medicines even though it may not be necessary. It all boils down to ethics and it is good that though late the government has decided to look into this matter," said Dr. Shrestha.

These apart, the new policies also include a number of other important points like classifying the nursing homes based on their physical infrastructure and service they provide and compulsory requirement of government permission to open or operate any hospital, nursing home or health laboratory. Likewise, the ministry has already formed a committee to frame its policy on test-tube babies and has made arrangements to provide 100 heart valves for free to needy patients each year from the Martyr Gangalal Heart Center.

The government will soon do away with legal obstacles and start the kidney transplant service from the Bir Hospital and one of the dialysis machines in the hospital will be used to provide free service to poor patients. The policy also announces setting up of a fund to help needy patients. The hospitals will have to pay 5 percent of their internal income to the fund and it will also attract 5 percent of the money government provides as subsidies to hospitals. The government also announces that it will make necessary additional arrangements to take care of victims of Maoist violence in districts.