Many developing countries face difficulties in funding health care leading to poor health, impoverishment and disparity. Amidst the ongoing concerns regarding the sustainability of social health insurance in Nepal, its importance in providing equitable health care remains undeniable.In 2005, the World Health Organization (WHO), recommended Social Health Insurance (SHI) as a strategy for mobilizing resources, pooling risks, providing equitable access to health care for the poor and delivering better health care. The Health Insurance Program was started in the year 2015, with the objective of improving the health status of all Nepali citizens and ultimately reaching the Universal Health Coverage (UHC) by the year 2030. The program relies on the contribution of government, families and service providers through the concept of broad social partnership. The health insurance program helps in the effective management of available resources by reducing out-of-pocket expenses of the insures. After six years of implementation, 5.4 million citizens and 1.65 million families from all 77 districts and 746 local levels have enrolled into the program.
While there has been commendable progress towards the expansion of health insurance program, it has not been able to retain the insures. According to Insurance Management Information System (IMIS), in the last fiscal year only 56.31% of the total insures renewed their plan. This is because there are not sufficient enrollment assistants at the local level for manual registration and renewal of memberships. The renewal rate is expected to increase in the upcoming years as this process has been made online from this year. Unavailability of services is also another reason behind high drop-out rate. If the services needed by the insures are not available at the time of need and have to pay out of pocket, they will eventuallyback out of the program. Availability of health services at the enlisted health facilities should be ensured in order to retain the insures and reduce the drop-out rate.Population coverage is one of the three dimensions of UHC and in order for Nepal to reach UHC, health insurance program needs further expansion.As of now, atotal of 450 health facilities are providing health services under the program. Health insurance program should be implemented in all the government health facilities and participation of private health facilities should also be increased.
Like majority of other programs in developing countries, focus has been given towards the developing and designing the program,neglecting its implementation and outcomes. For health insurance program to be sustainable and self-sufficient it has to be made mandatory for all the citizens. The pooling of the fundsneeded for the program to be sustainable is only possible if all the citizens despite their age, health condition and socio-economic status enroll in it. From policy level, the existing number of human resources should be increased focusing on the employment of skilled human resources. The number of enrollment assistants should also be upscaled throughout the country especially at local levels. The existing IT system, IMIS should be strengthened and regularly updated. All the financial transactions of the health insurance program should be digital and transparent. The expansion and sustainability of the program of this magnitude requires a collective effort. Effective implementation of the said policy interventions is only possible with strong political commitment, sustained financial support from the government and donors,persistent efforts of the health insurance board, service providing health facilities, insuresand other stakeholders.
-(Suvekshya Tiwari: MSc Health Economics, University of York)
