The poor’s access to free healthcare is challenging in Nepal. What happens next?

free healthcare
Patients wait for free healthcare.

The government’s programme ‘Bipanna Nagarik Ausadhi Upachar Karaykram’ (Poor Citizens Medical Treatment Programme), which gives free healthcare to poor patients struggling with eight complex diseases, has been merged into the health insurance programme. Following this, questions have been raised about its effectiveness.

When this programme was under the Nursing and Social Security Division of the Department of Health Services, the patients would get free healthcare at certain hospitals and the government would pay the amount to the hospital after it submitted the patient’s report(s).

However, with new changes, poor patients are facing unnecessary hassles in the Health Insurance Board to get free healthcare services. This has increased the risk of poor citizens being deprived of health services.

The existing challenge

The Ministry of Health and Population included the medical treatment programme for the poor in the health insurance programme last April.

However, the contracts of the listed hospitals have not been renewed, and neither have they signed new contracts with them. And, for the last five months, the hospitals have not been able to get any payment for the treatments they have provided to the patients.

Health Secretary Dr Roshan Pokharel says the board has full ownership of the programme as per the new procedure. Pokharel says the board is responsible for funding the hospital’s contract renewal.

The Department of Health Services.

A former head of the division says that it was a mistake to assign the medical care facility for poor citizens with severe diseases to the Health Insurance Board without any preparation.

Goma Niraula, the head of the Nursing and Social Security Division, says there is a staff shortage. “Also while going for hospital monitoring, many service-providing organisations have complained about not being able to get their payment,” Niraula tells Onlinekhabar, “There was a lack of coordination due to having the same programme in two different systems.”

Most hospitals do not want to start the insurance scheme because the board cannot pay for the health insurance programme. Some hospitals have even announced that they are stopping free healthcare services indefinitely.

The Health Insurance Board has also not been able to speed up the health insurance programme. Hence, a former chief of the board says, “Around 60,000 poor patients will suffer as the medical care programme for the poor citizens has been merged without preparation.”

The said programme is the government’s first priority and a successful programme. “However, it seems that it has become problematic when a programme is divided between two systems. There is no room for one to escape by pointing the blame at the other body,” he adds.

According to the statistics of the Nursing Division, the number of patients receiving free healthcare services through the medical care programme for poor citizens is decreasing. In the fiscal year 2019/20, there were 54,837 patients whereas 29,346 in 2020/21, and 35,537 in 2020/22.

In the fiscal year 2020/21 there were 8,302 cancer patients, 6,001 heart patients, 8,231 kidney patients (747 transplanted), 63 Parkinson patients, 10 Alzheimer patients, 513 head injury patients, 1,132 spinal injury patients, and 1,226 sickle cell anaemia patients who have received the free healthcare services.

The patient gets this free service only once. The government has been allocating Rs 2.48 billion annually for this.

What next?

File: Ministry of Health and Population
File: Ministry of Health and Population

The government has listed 107 hospitals across the country for free healthcare for heart, kidney, cancer, Parkinson’s, Alzheimer, spinal injury, head injury and sickle cell anaemia patients.

Out of that, kidney patients get Rs 400,000 for transplant and free dialysis, Rs 100,000 for medication after transplant, and up to Rs 50,000 for cross-checking of kidney donors and recipients. Similarly, it has been providing free treatment services up to Rs 100,000 for the treatment of heart, cancer, spinal injury, Parkinson’s, sickle cell, Alzheimer’s and head injury.

When the poor citizen medical care programme was under the Nursing Division, there was a system of payment to the listed hospitals based on the monthly report through the meeting of the Poor Citizen Medical Treatment Management Committee.

Damodar Basaula, the executive director of the Health Insurance Board, claims that the new confusion is attributed to the weakness of the ministry and the Nursing Division. “The board only gives payment. The task of renewing, registering and monitoring the contract of the hospital is the responsibility of the division,” Basaula says, adding that the incomplete programme has come to the board and is creating more problems.

“We cannot run an incomplete programme. If it is to be given to the board, it should be given all the ownership,” Basaula adds, “’The programme cannot be made effective by dividing the work between the two agencies.”

The Ministry of Health’s spokesperson Dr Sanjay Kumar Thakur says that the free healthcare programme has been merged with the Insurance Board to prevent one person from getting double benefits from the government.

“The government is trying to provide free healthcare services through a one-door system. However, the system is facing some technical problems,” he assures, “But, we will solve it within a few days.”

This story was translated from the original Nepali version and edited for clarity and length.

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Chaulagain is an Onlinekhabar health correspondent.

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