Medicosnext
The Health Insurance Board has rolled out a new co-payment system, necessitating insured individuals to bear 10 percent of their treatment expenses. Dr. Damodar Basaula, the Executive Director of the Health Insurance Board, emphasized that this initiative, effective January 15, is designed to counter the trend of insured patients insisting on unnecessary comprehensive health examinations.
The underlying rationale behind the 10 percent co-payment is to discourage superfluous medical tests driven by insured individuals who might perceive their entitled benefits as underutilized by hospitals. Responding to concerns about certain private hospitals conducting arbitrary tests on patients with health insurance coverage, the co-payment system places 10 percent of the financial responsibility on the insured individual.
The 10 percent co-payment will be applicable to a range of services offered by designated hospitals, covering both external and internal medical procedures, diagnostic tests, therapeutic interventions, surgeries, physiotherapy, rehabilitation, and more. However, this provision excludes programs provided free of charge by the Nepal government, including maternal protection, childhood disease management, tuberculosis and leprosy treatments, and various public health services.
Dr. Gunaraj Lohani clarified that the co-payment system would not be enforced in primary health centers, government hospitals with up to 25 beds, and specific government-run programs. Additionally, the revised cost of the Outpatient Department (OPD) package has been announced, reducing fees for insured individuals from Rs. 200 to Rs. 50, and emergency fees from Rs. 400 to Rs. 100.
