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, the patients would get free healthcare at certain hospitals and the government would pay the amount to the hospital to the latter after it submitted the patient’s report(s).
However, with new changes and unprepared health insurance programmes, 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 poor citizens in the health insurance programme last April.
However, the contract of the listed hospital has 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.
Secretary of the Ministry of Health Dr Roshan Pokharel says that the procedure has been made as such where the Board has full ownership of the programme. Pokharel says the board is responsible for funding the hospital’s contract renewal.
“The board was coordinating with the division due to lack of human resources but the said programme could not take action,” says Pokharel, “It was already assumed in a meeting that the programme would fail. However, the board took it anyway.”
A former head of the division says that it was a mistake to take the medical care facility for poor citizens with severe diseases to the insurance board without any preparation.
Goma Niraula, 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, “It is evident as there is a lack of coordination due to having the same programme in two different systems.”
Most hospitals do not want to join the insurance board because the board cannot pay for the health insurance programme. Some hospitals have even announced that it is stopping free healthcare services indefinitely.
The insurance board has also not been able to speed up the health insurance programme. The programme is directly connected with the poor, says the former chief in a conversation with Onlinekhabar, “However, 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; 29,346 in 2020/21, and 35,537 in 2020/22 who have taken the free healthcare services of this programme.
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 services.
The patient gets this free service only once. The government has been allocating Rs 2.48 billion annually for this.
What next?
The government has listed 107 hospitals across the country for free medical care for heart, kidney, cancer, Parkinson’s, Alzheimer, spinal injury, head injury and sickle cell anaemia patients.
Out of which, kidney patients will 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, Executive Director of the Health Insurance Board, claims that this situation is due to the weakness of the Ministry and the Nursing Division. The board will only give 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 parties.”
Ministry of Health’s spokesperson Dr Sanjay Kumar Thakur says that the 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 health services through a one-door system. However, the system is facing some technical problems but we will solve it within a few days,” says Thakur.
This story was translated from the original Nepali version and edited for clarity and length.
The post Poor citizens’ access to free healthcare has become more challenging. What happens next? appeared first on OnlineKhabar English News.
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