National Health Policy 2014

National Health Policy 2014

 This policy states that:

• A national insurance policy will be put into place by passing laws and following implementation guidelines in order to guarantee the delivery of an accessible health service by making financial management viable. Subsidies will be given to those who cannot and are financially struggling.
• Provision shall be made for citizens to access high-quality medical care as a fundamental right.
• Programs shall be created and put into action in a way that ensures the health services provided by the state are available to underprivileged, marginalized, and vulnerable groups and are based on equity and social justice.
• To ensure that this policy and the initiatives it contains are effectively implemented, resources from both internal and external agencies will be utilized.

Ordinance for formation of Social Health Security Development Committee 2015

• The Social Health Security Development Committee (SHSDC) was founded to ensure that all Nepalese citizens have access to high-quality healthcare at reasonable prices. SHSDC was established in accordance with the Development Act of 2013 BS (1958 A.D.), which was released in the Nepal Gazette on February 9, 2015.

Social Health Security Program Operating Rule, 2015

• On September 18, 2015, the cabinet approved Standard Operating Procedure (SOP) to operationalize the Social Health Security Program in accordance with the ordinance for its development. It serves as the foundation for the Social Health Security Program's operation.

Nepal Health Sector Strategy (NHSS 2015 - 2020)

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

"NHSS outlines the necessary service delivery arrangements so that UHC can be achieved. It establishes the Basic Health Package and demands for free basic health services to be provided to all citizens. Different social health protection systems, such as health insurance, are used to supply services that are outside the scope of the basic health package. "

Sustainable Development Goals

• By 2030, the Sustainable Development Goals want to ensure that everyone has access to quality, affordable, safe, and effective critical medicines and vaccines. They also want to protect people from financial risk.
• Additionally, it aspires to put in place social protection systems and policies that are suitable for every country by 2030, with a focus on achieving significant coverage for the weak and the destitute.

Guidelines for Selection of Enrollment Assistants (Second Amendment), 2074 BS

Provisions in the Guidelines for selection of enrollment assistants of Social Health Security (Health Insurance) Program (Second Amendment, 2074), National Health Policy, 2013

Background

In accordance with Nepal's 2007 interim constitution, all residents are entitled to free basic healthcare as a human right. As a result, the Nepali government has made some health care services universally accessible and is offering supplemental services to specific groups. Although there has been a slow improvement in access to healthcare, there is still a long way to go before everyone is covered, and private households spend a lot of money out of their own pockets. The private sector accounts for the majority of this expenditure on pharmaceuticals. Additionally, the government's ability to encourage healthcare providers to increase productivity, quality, and efficiency is constrained by Nepal's current health financing structure.The unrestricted out-of-pocket spending must be captured by a national health insurance scheme in order to facilitate the effective and accountable management of the available resources.

The National Health Reform Policy for 2013 was created by the government to provide direction for the Three-Year (2010–2011–2012–2013) program in Nepal. The Nepal Health Sector Programme II (2010–2015) aims to enhance access to high-quality health care services, particularly for members of underserved population groups. The National Health Insurance Policy will help this goal. The goal of this significant reform plan, policy 1, is to strengthen the health systems while also enhancing public health. The policy also complies with the National Social Protection Framework, which is significant.The next Health Finance Strategy will offer direction on how the various financing mechanisms in Nepal are interconnected. The National Health Insurance Nepal Health Insurance Policy 20132Policy will be complemented by other upcoming policy and legal documents on state and non-state partnerships in the health sector, such as the urban health policy (draft available) and health institutions operation (draft available), which will help to effectively implement a national health insurance program in Nepal.

Policy rationale

As per the Three Year Plan (2010/11-2012/13) and the Health Sector Programmell(2010 2015), a National Health Insurance Policy is needed to improve the health situation of the people of Nepal. Specifically, this policy is needed to:

• By removing financial barriers to the use of health care services, with an emphasis on the poor and marginalized, we can promote accessibility to and equity in the provision of health care services.
• By implementing a national health insurance policy, you can mobilize financial resources for healthcare in an equitable way while promoting pre-payment and risk-sharing mechanisms.
• Improve the efficacy, efficiency, accountability, and quality of care in the provision of healthcare services by encouraging output-oriented spending in the sector.
• Strengthen systems and an integrated approach to health.
• Enhance the public's desire for health by communicating a shift in behavior, boosting awareness, and providing clear entitlement procedures.

Long-term goal and main objectives

Long-term goal

• The long-term goal of this policy is to improve the overall health situation of the people of Nepal.

Main objective

• The main objective of this policy is to ensure universal health coverage by increasing access to, and utilisation of, necessary quality health  services.

Specific objectives

The specific objectives of this policy are to:

• By encouraging pre-payment and risk pooling in the healthcare industry, the public's financial security will be increased.
• Make equal use of financial resources.
• Boost the delivery of healthcare services' efficacy, efficiency, accountability, and quality of care.

Strategy 1

To meet the first objective (increase financial protection) the National Health Insurance Programme will:

• Lessen out-of-pocket costs when using healthcare services.
• Mobilize neighborhood organizations to encourage more people to take part in the initiative.
• Put money together and distribute it fairly.
• Implement a range of initiatives and activities to progressively enhance health.
• The actions of those who are seeking.
• Be implemented throughout the entire nation gradually.

Strategy 2

To meet the second objective (mobilize financial resources in an equitable manner) the National Health Insurance Programme will:

• Encourage prepayment by requesting household contributions.
• To secure the participation of the target and impoverished demographic groups, receive special funding.
• Get more resources to make it possible for it to be started and carried out in a sustainable way.
• Include each and every home in Nepal.

Strategy 3

To meet the third objective (improve the effectiveness, efficiency, accountability and quality of care in the delivery of health care services) the National Health Insurance Programme will:

• Regulating/Coordinating Mechanism.
• Introduce provider payment mechanisms.
• Integrate existing social health protection interventions and programmes into the National Health Insurance Programme, as feasible.
• Develop a national framework to integrate government supported health insurance initiatives and promote complementarity with other private insurance schemes.
• Promote the participation of governmental, non-governmental and community organisations, and public private-partnerships in implementation of the National Health Insurance Programme.
• Motivate health workers and facilities to provide quality health services.
• Develop a system to control moral hazard and other risks that may arise in relation to service consumers; and providers and service.
• Promote output-oriented expenses.

Ministry of Health and Population shall continue existing health care services not covered by the NHIP.

Implementation

Program Implementation Status

The current health insurance scheme was launched in the Kailali district on Chaitra 25, 2072. On FY 2073/74, it is then extended to the districts of Lilam and Baglung. By the end of FY 2074/75, 36 districts across the nation have adopted the program. The initiative will be in place in 46 districts across the nation by the end of FY 2075/76, and the next 7 districts are already in the works. Additionally, HIB intends to roll out this service nationwide. The table below lists the districts that the HIB program has been launched in.

Enrollment and Health service utilizationStatus of fiscal year 2075/76

13,507 people were covered by insurance in the FY 2072–73, 228,113 in the FY 2073–74, and 1,130,575 in the FY 2074–75. At the end of FY 2075/76, 147,938 persons had reenrolled in the health insurance program, of whom 16,40,879 were active members and 507,059 had dropped out. Among these, 293,958 people are insured under the ultra-poor category, with the Nepal Government providing the entire cost in FY 2075/76. In areas with implementation, the percentage of the population covered by health insurance appeared to be around 14% of the entire population. About 708,406 of the total insured individuals used health services from one of the facilities mentioned in the health insurance program for the fiscal year 2075–1976. Based on the number of enrollments Jhapa, Chitwan, Palpa and Sunsari are leading top four districts, followed by Kaski and Kailali. 

Opportunities in Health Insurance program

• The program is addressed in Constitution of Nepal 2072, in Art no.51 of State' guideline principle.
• Health Insurance Act 2074 has envisioned the compulsory enrollment of people working in formal sector.
• High political commitment.
• Designed as tool for providing equitable and quality health service.
• Health system strengthening (generic prescribing, hospital pharmacy, gate keeping system) Sustainable approach to provide social health security to Nepalese people.

Challenges in Health Insurance program

• Meeting the expectation of insured people.
• Raising the number of enrollment and renewal.
• Availability and accessibility of quality health service
• • Strengthening of insurance management information system (IMIS) Identification of target group and their enrollment (ultra poor etc) Poverty card related issues.
• Fragmented social health security program (within MoHP and beyond)