Presentation by Shambhu Prasad Jnawali, Spokesperson, Health Insurance Board Nepal (19.04.2023)
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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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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