Republica and Nagarik have revealed that a multi-billion-rupee universal insurance scheme is in deep trouble. The Universal Health Coverage (UHC) scheme has not been able to spend the allocated money each year, the drop outs from the scheme is high in many remote districts and the coverage has not reached a majority of the people. In the meantime Health Minister Upendra Yadav is off to New York for a two-week trip. The government wants to insure at least 50 percent of the population by 2020 and 100 percent by 2030. At current pace, both the targets are unlikely to be met. Only seven percent of the country’s population has been covered by the scheme so far. The Health Insurance Act, 2017 mandates that every Nepali citizen is enrolled in a health insurance program.
Less than half of the allocated six billion rupees for the project has been spent so far in Fiscal Year 2018/19. The spending figure was around 25 percent in FY 2016/17. The scheme was introduced in 2016 to support and protect the most vulnerable and reduce their out-of-pocket expenses. The out-of-pocket expense for medical treatment stands a whopping 55 percent, compared to 10-20 percent in the developed countries. The government pays 100 percent of the premium for the ultra-poor. However, the program is yet to reach the poorest. Of the 2.2 million enrolled, around 25 percent have already dropped out of the program and this is a serious case. Logistics of the scheme is impacting the effectiveness of the program. Better coordination and buy-in from provincial and local governments will only ensure the sustainability and impact of the scheme.
Our leaders and top officials often sell high-sounding dreams of big projects without conducting thorough study about long-term feasibility of such schemes and availability of experts and resources required to run such programs. Therefore, many of our big projects can’t gather momentum as they are carried out without adequate preparation. We suffer from logistical, administrative and political issues in these projects and we never seem to learn from other big projects that have not progressed very well. At the end, such programs don’t yield positive outputs and the targeted communities are hardly benefited even after spending billions of rupees for the same. Despite budgetary support, projects like UHC suffer at the hands of incompetent bureaucrats and corrupt politicians. So it’s high time the policy makers did soul-searching on this issue and Prime Minister KP Sharma Oli and his team should immediately figure out the details of UHC and implement the project so thar the poorest benefit from it.