Skip to main content

Health Insurance In Nepal Social Health Security Program In Nepal

 Health Insurance In Nepal or The Social Health Security Program (SHSP) is a social security program of the Government of Nepal who intends to empower its citizens to get quality healthcare services without putting a financial burden on these. The families, communities and authorities are involved in this system or health insurance in Nepal. SHSP helps stop individuals from falling into poverty because of healthcare costs i.e. catastrophic cost because of injuries or disease by blending prepayment and risk pooling with mutual assistance. This program also urges towards quality health care services. This system tries to deal with obstacles in health service usage and ensure fairness and accessibility of poor and disadvantaged groups as a way to attain Universal Health Coverage.

Health Insurance in Nepal an Overview

A historical initiative to health insurance in Nepal started from 1976 through United Mission to Nepal (UMN) as Lalitpur Medical Insurance Scheme from Ashrang, that was later enlarged to other centers. The government financed community-based medical insurance plan was pioneered in 2003 at two districts and enlarged to further four districts in 2005/06. National Health Insurance Policy has been passed by Government of Nepal at 2014. In 9th Feb 2015, that the ordinance for creation of Social Health Security Development Committee has been passed by Government of Nepal and printed in the Nepal Gazette. SHS app expects to offer an important contribution for assisting Nepal change in the list of Least Developed Nations to Middle Income Developing Nations at the end of 2022.

Social Health Security (Health Insurance in Nepal) Software is necessary to enhance the health condition of the people of Nepal. Especially, this program is Required to;

  • Increase availability to, and equity in, the supply of healthcare services by eliminating financial barriers to using healthcare providers, focusing on the poor and marginalized;
  • promote pre-payment and risk pooling mechanisms to mobilize financial resources for wellness in an equitable way;
  • promote output-oriented expenditure in the health industry and enhance the effectiveness, efficiency, accountability and quality of care in the delivery of healthcare providers;
  • fortify health systems in an integrated way; and
  • enhance the health seeking behavior of the general public through apparent entitlement procedures, consciousness raising and behavior change communication.

Health Insurance In Nepal  Long-Term Goal

The long-term objective is to enhance the general health status of Nepalese Citizens.

Health Insurance In Nepal Aims

Health Insurance In Nepal  - Main Objective

  • To guarantee Universal Health Coverage by gaining accessibility to, and use of necessary excellent health services.

Health Insurance in Nepal - Certain goals

  • To grow the financial security of the general public by encouraging pre-payment and risk pooling from the health industry;
  • To mobilize financial resources in a reasonable way; and
  • To enhance the effectiveness, efficiency, accountability and quality of care in the delivery of medical care services.

Health Insurance In Nepal

Health Insurance In Nepal - Plans

  • Increasing involvement of communities towards health insurance plan by offering special coverage to the poor and marginalized and
  • Increasing coordination and collaboration with both government and nongovernment service supplier health associations for slow expansion of health insurance plan around the nation.

Health Insurance In Nepal - Essential Features

  • It's a voluntary program based on household gifts.
  • Families of as many as five members need to donate NPR 2,500 annually and NPR 425 per extra member.
  • It supplies subsidized prices for households whose members have a poverty identification card.
  • Registration continues through the entire year in employed districts.
  • Insurees must renew their membership through yearly donations.
  • Advantages of around NPR 50,000 annually are offered for households of up to five members having an extra NPR 10,000 coated for each additional member. The maximum amount available annually is NPR 100,000.
  • Insurees must select their very first service stage but can additionally access providers from authorities PHCCs and hospitals and recorded hospitals.
  • Insurees can get technical services elsewhere which aren't accessible at the initial service point on creation of a referral slip from their very first contact stage.
  • It's cash-less method for members looking for health services. Upon introducing their SHSP membership ID card in a gym, members can obtain the health services and medication covered by the benefit package without needing to cover at any point.
  • For crises, insurees can get services from any service stage with no referral slip.
  • The app is IT-based with registration assistants employing smart phones.
  • Purchaser-Provider Split: SHSDC functions as the support buyer whilst authorities and recorded private hospitals offer the services.
  • Premium levels are subsidized by the Government in predetermined rates for the exceptionally poor, vulnerable or poor. A household identified as impoverished, weak and marginalised get 100 percent , 75 percent and 50 percent reductions respectively. FCHVs get NRS 250 reduction in their own family donation.
  • Article 35 has provision for directly to free basic health services under which subsequent provisions have been created
  • Every citizen will be entitled to free basic health services in the State, and no one will be deprived of emergency health services
  • Each individual shall be able to find details regarding their medical care.
  • Every taxpayer will have equal access to medical care services.
  • The indigent citizens, incapacitated and helpless citizens, helpless unmarried ladies, citizens with disabilities, children, taxpayers who aren't able to deal with themselves and taxpayers belonging to the tribes on the point of extinction will be entitled to social security, in accord with law.
  • In'Part 4: Directive Principles, Regulations, and Duties of the State'
  • The purpose 15 contained in the'policies concerning basic needs of their citizens [component 4-51(h)] under policies of this nation ensures accessibility to medical treatment whilst ensuring taxpayer's health .
  • This action makes provisions for registration of government workers and families of overseas labour into health insurance plan.
  • In line with this action, the obligation for registering children, elderly and differently abled individuals are entrusted for their parents or caretakers.
  • Families are thought of as the device for registration into health insurance plan.

National Health Policy 2014

This policy states that

  • so as to guarantee delivery of an available health agency by making fiscal management renewable, a nationally insurance plan will be implemented by creating legislation and execution guidelines. People that are not able and fiscally poor will be supplied subsidies.
  • As a basic right of citizens, provision for getting quality health care will be guaranteed.
  • So as to guarantee the health services supplied from the nation is available to poor, marginalized and vulnerable communities; predicated on equality and social justice, programs will be made and executed appropriately.
  • Resources obtained from internal and outside agencies will be mobilized for successful implementation of the policy and the applications devised under this policy. The most important purpose of this policy would be to guarantee universal health care by increasing accessibility to, and use of, necessary excellent health services.

Ordinance for creation of Social Health Security Development Committee 2015

Social Health Security Development Committee (SHSDC) is made to offer Health security policy and make sure accessibility, usage of quality health services in a reasonable price for many citizens of Nepal. SHSDC is shaped under Development Act, 2013 BS (1958 A.D.) and printed in Nepal gazette at 09 February 2015. It provides foundation for the performance of their Social Health Security Program.

Nepal Health Sector Strategy (2015-20) says that:

"To be able to proceed towards UHC, NHSS lays out the most essential service delivery agreements.

 It requires fundamental health care services, which can be delivered for free to the taxpayers, and defines the Basic Health Package.

 Services which are beyond the range of general health package are sent via distinct social health protection agreements, such as health insurance".

Sustainable Development Aims

Sustainable Development Goal aims to attain universal health care, such as financial risk protection, access to quality crucial health-care providers and access to safe, efficient, quality and more affordable essential medicines and vaccines for all by 2030.

Additionally, it intends to employ nationally appropriate social security systems and steps for everybody, by 2030 attain significant protection of the poor and the vulnerable.

Strategies for Choice of Enrollment Assistants (Second Amendment), 2074 BS

Provisions from the Guidelines for choice of registration assistants of Social Health Security (Health Insurance) Software (Second Amendment, 2074).

Tags: Health Insurance In Nepal, Health Insurance policy In Nepal, Social  Health Security Program In Nepal