The Health Insurance Board’s District Contact Office in Bardiya reports that 95 percent of households in the district lack access to health insurance. According to the 2021 National Health Census, Bardiya has 106,285 households. However, only 5,555 households are receiving regular health insurance services, as stated by Dikendra Bahadur Bista, the district coordinator of the Health Insurance Board. Among them, 17,915 senior citizens aged 70 and above are enrolled in health insurance. According to the Health Insurance Board, since the establishment of the office, a total of 41,335 households have registered for health insurance, as per the office’s data. The data appears higher because the board counts one senior citizen as one household. Currently, the number of households enrolled in health insurance stands at 23,420. However, after excluding the number of senior citizens, only 5,555 households in the district have access to health insurance.
Health Insurance Process Found to Be Complicated for Service Users
Health insurance beneficiaries have complained about the complicated process of getting treatment through insurance. Manbahadur Chaudhary of Gulariya Municipality-4 said that although health insurance provided some financial relief, the process was still difficult.
He mentioned that the different policies set by the Health Insurance Board, such as providing free treatment in 15-bed hospitals, charging 10 percent in hospitals with more than 15 beds, and 20 percent in private hospitals, have put service recipients in a difficult position. He stated that he is ready to complete the health insurance process for treatment. However, he highlighted the issue of standing in line all day for medicine, only to be told that the medicine isn’t covered by the insurance. He pointed out the lack of clarity regarding which medicines are included in the insurance and shared his frustration when pharmacy staff inform him that certain medicines are not covered. He also mentioned that even check-ups are sometimes excluded from the health insurance coverage.
It is essential for patients to know which treatments are covered by insurance and which are not. Many citizens enrolled in the insurance scheme have expressed dissatisfaction with the benefits. Even with insurance, they often face situations where prescribed medicines are unavailable at health institutions, forcing them to buy medications at their own expense.
According to Article 35 of the Constitution of Nepal, the right to health is guaranteed to every citizen. This article stipulates that each citizen is entitled to free basic health services provided by the state and ensures that no one shall be denied emergency health services. Similarly, it is stipulated that every citizen has the right to access information regarding their health treatment, and it ensures that all citizens have equal access to health services.
The Health Insurance Board was established in accordance with the National Health Insurance Policy 2014 and the Health Insurance Act 2017 to implement health insurance. Despite the presence of registered assistants in each ward, individuals with disabilities still remain outside the reach of health insurance.
Hima Sunar, the coordinator of the Civil Society Network, stated that the number of people enrolling in health insurance has decreased because patients receiving treatment through health insurance are treated differently. She said, “In some hospitals, insured patients face issues such as waiting longer for their turn, while those paying in cash receive immediate care.” Although the health insurance program introduced by the government is good, its weak aspects should be improved. It is necessary to connect everyone to health insurance by spreading propaganda about health insurance.
Free health insurance
The Health Insurance Board has provided free health services to families of senior citizens, individuals with disabilities, and those affected by leprosy, MDR-TB and HIV. Rajesh Dhakal, the Information Officer of the Health Insurance Board, confirmed that these families are receiving free health services. He mentioned that since the establishment of the Health Insurance Board in 2017, it has been working in the district by placing registration assistants in 75 wards across eight local levels. He stated, “The Health Insurance Board has provided free health insurance to 17,915 senior citizens, 882 individuals with disabilities, 127 people with HIV, 18 individuals with leprosy, and 9 people with MDR-TB. Additionally, women health volunteers receive a 50 percent discount on the fees when obtaining health insurance.”
Formation of Local Level Health Insurance Coordination Committees
Out of the eight local levels in Bardiya, only Barbardiya, Bansgadhi, and Thakurbaba Municipalities have formed a Health Insurance Coordination Committee. The Health Insurance Board has established a legal provision for the formation of Local Level Health Insurance Coordination Committees to facilitate the implementation of insurance at the local level. However, Gulariya, Rajapur, Madhuban Municipalities, and Geruwa and Badaiyatal Rural Municipalities in Bardiya have not yet formed a Health Insurance Coordination Committee.