Presentation by Shambhu Prasad Jnawali, Spokesperson, Health Insurance Board Nepal (19.04.2023)
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Context
there have been 7 game changing health programs by the government of Nepal, one out of them is the health insurance program
strong legal foundation for HIB / this health insurance program – one of the priority program of the government of Nepal
major roles & responsibilities of HIB
Policy and system development
Enrollment of membership: (registration and renewal)
Listing or delisting of health service providers
Claim management
Main operation tools is Insurance management information system
Capacity enhancement to HIB staffs and Service providers
Demand generation activities/community engagements
Grievances management
Update of the benefit package
Monitoring and Evaluation
National Social Health Insurance by HIB is a contributory scheme for the informal sector
Specifics of contribution and benefit
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Major features of the program from provider perspective
Purchaser and Provider Split (HIB=purchaser, hospitals= provider)
IT-based (openIMIS)
subsidy (of government to premiums) to poor and targeted population (e.g. 70 years and older, HIV or leprosy patients)
contributory / family (household of 5 family members) based
cash-less and upper cap
public and private providers on medical services
Enrolment figures:
nationwide 77 districts covered
close to 2 Mio families, 6.4 Mio beneficiaries
458 providers under HIB (91% public providers, 9% private) – unequally distributed over municipalities, strong urban focus = lack of coverage in some rural areas
HIB expects more social health protections schemes incl. for formal sector to be integrated under HIB (for sustainability of HIB activities, formal sector brings in more contributions by insured employees)
Way forward for HIB
system digitalisation (online referral system, online renewal system, online registration etc., API for claim management)
improve claim management system (e.g. AI module in support of manual claim review9
increase enrolled and renewal rate
introduce co-payment system
regular monitoring and training (to staff of health service providers)
Alexander Schrade, Senior Policy Officer, Division Health, Social Protection and Population Policy Division / German Federal Ministry of Economic Cooperation and Development (BMZ) “This open source software, openIMIS, is quite a valuable tool in your (the HIB) endeavour to bring more people under health coverage as well as in creating an integrated system as the key and backbone for improving the health system. We have seen that there are still some gaps in the integration and exchange of data between IT systems, which we need to further work on. I think with the support of our (BMZ-funded) bilateral health program you can further build on openIMIS.” |
Discussion, Q & A
… On funding of the National Social Health Insurance, definition of premium level and eligibility to subsidies
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