KATHMANDU, Jan 16: The Health Insurance Board (HIB) has made it a requirement that the insured who receives treatment under the insurance program has to pay only 10 percent of the treatment cost (co-payment).
HIB Executive Director Dr Damodar Basaula said that the insured has to pay 10 percent of the cost of using health services under the health insurance program from Monday.
Earlier, no insured person had to pay for the treatment due to affiliation with the HIB. There is a provision that families with up to five members can get benefits of up to Rs 100,000 by paying an annual contribution of Rs 3,500. He said that the co-payment system was implemented as a test to discourage unnecessary health tests.
“The insured began to pressure the doctors unnecessarily to conduct health check-ups,” he said, “To discourage them, we have decided to make the insured pay 10 percent of the btreatment cost so that medical examinations are conducted only when necessary." According to him, the insured does not have to pay 10 percent for the medical treatment provided in primary health centers and hospitals with up to 25 beds.
The co-payment system is applicable in federal hospitals, provincial and territorial hospitals with more than 25 beds and all private and community hospitals. So far, a total of 7.47 million people are covered by insurance and out of them 3.48 million people have taken health services through the insurance program, according to Om Kumari Kandel, information officer of the HIB. According to Kandel, there are currently 4.86 million active insured persons.
Similarly, it has been mentioned in the procedure that the co-payment system (10 percent amount to be paid) will not be applied to the very poor, senior citizens above 70 years, severely disabled, HIV-infected, complex tuberculosis patients, leprosy patients and women health volunteers.