Kathmandu. Health Minister Pradeep Paudel, who made a popular announcement to increase the sum insured of health insurance to Rs. 500,000, has started expressing that health insurance is on the verge of being discontinued.
Minister Paudel had announced that the sum insured would be increased from Rs. 200,000 to Rs. 500,000 to increase the security of insurance and provide easy health care services to the citizens. A task force was formed in this regard and a report with suggestions was prepared. Now he himself has started lamenting that the health insurance program will not be able to be operated with the government’s resources.
Minister for Health and Population Pradeep Paudel had submitted an action plan related to health insurance reform to Prime Minister KP Sharma Oli on Magh 16. Minister Paudel has appointed Additional Secretary of the Ministry Dr. A suggestion committee was formed under the leadership of Tanka Barakoti. Minister Poudel’s secretariat informed that the report included content that could reach the target of Rs. 500,000.
At a public program organized in the capital this week, Minister Poudel said that the budget allocated by the government of Rs. 7.5 billion has already been used up, if the same amount is maintained, it will reach Rs. 40 billion this year. He mentioned that Rs. 16 billion of payments from recent years are yet to be settled, and said, if this amount is maintained, it cannot be operated anymore, even if it is not closed, it will close on its own.
According to him, such a problem has arisen due to misuse of government facilities by both service recipients and health service providers under the health insurance program. He claims that the tendency to test for diseases that should not be tested and to buy medicines that should not be taken has resulted in a misuse of government funds.
When Minister Paudel took office, he must have been aware of how much money the government had allocated for the current year, how much was left over from the past, and how strong the government’s resources were. Despite having all this information, he embarked on a popular campaign to more than double the insurance amount, announcing it from a public platform without prior preparation. He managed to gather applause, but now the situation is like this.
Recently, the Rapti Institute of Health Sciences, Dang, has issued a public statement saying that the hospital is in financial crisis due to the Health Insurance Board not paying for treatment and medicines. According to the foundation, the board is yet to reimburse Rs 110 million from last year. After not receiving payment for treatment expenses, the foundation has limited services such as medicine distribution, health check-ups and others under the insurance program.
The health insurance program is an ambitious social security program of the government. The issue of misuse of government funds, especially by private health institutions and medical colleges, in the guise of fake treatment, fake bill generation and unnecessary treatment, has been discussed repeatedly. But the insurance board is helpless to stop such misuse, the insurance board does not have the technology to automatically settle claims. Based on political pressure and influence, private health institutions and medical colleges have been taking claim payments.
The system in India is as follows:
In India, an integrated payment system has been implemented to prevent health insurance claim abuse. All health institutions providing services have been linked to the completely cashless claim settlement system. When those institutions conduct any examination or prepare a laboratory test report, all the details must be entered into this integrated system immediately. In addition, all insured persons have been included in this payment system on the basis of Aadhaar card (citizen identity card).
Since the system is AI (artificial intelligence), if an abnormal health test is found on a person or if the background of health treatment is examined, the AI rejects the claim. Since human involvement is limited, there is no possibility of political influence or unfair advantage by intimidating or bribing the employees of the insurance board.
