Presentation by Shambhu Prasad Jnawali, Spokesperson, Health Insurance Board Nepal (19.04.2023)
| View file | ||
|---|---|---|
|
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
...
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
The National Social Health Insurance is a voluntary program, based on family contributions; families of up to five members have to contribute NPR 3,500 per year and NPR 700 per additional member; the premium is 100.000 NRP per year per household
HIB was able to identify exemptions for the poor in 26 (out of 77) districts .
30% of funding of health services are paid out of HIB re-imbursement funds, 70% are paid from the government budget – means currently strong dependence on government budget allocation (background: news in April 2023 on budget cut for health by around 42% )
HIB cannot cover all medical services from premiums collection, so the government provides subsidies yearly to re-imburse services to hospitals for e.g. elderly and those who cannot pay premiums; question of from whom to collect contributions and for whom to subsidies access to medical services
though insurance for the informal sector is mandatory, it is not mandatory in practice in Nepal - challenges in enacting it on the local level …
awareness of households of health insurance
actual coverage of some provinces with health service providers, e.g. in remote areas
HIB expectations to raise share from re-imbursement fund and lower share from government / efforts to raise premium collection to make health insurance (funding) more sustainable
some local governments try to make health insurance mandatory and tie it with other government services to ensure collection of more premiums.
practically enact compulsory health insurance in informal sector
Integrate formal sector health insurance with those working being able to pay higher premiums
Integrate other parallel government services and avoid duplications in administration
...
HIB receiving 25.000 claims / day
openIMIS AI claims module intended to support timely claims management
Illustration of openIMIS managed business processes under HIB Social Health Insurance scheme