Barack Obama’s initiative to cover all Americans through a universal healthcare scheme was nearly thwarted by the House and Senate Republicans, before the US Supreme Court approved a watered-down version of his signature legislation late June. Had the court struck it down, political pundits predicted, Obama would have been in deep trouble in the upcoming presidential election in November. There is likely to be no such opposition to Nepal’s own version of universal healthcare, the universal health insurance policy, that the government is in the process of finalizing. The policy, which aims to provide affordable health services to Nepali families from all income brackets, is expected to significantly expand the coverage of healthcare in the country (as things stand, as much as 50 percent of Nepalis are deprived of even primary healthcare services).
The existing government policy of providing highly subsidized medical care has proven inadequate as such programs do not cover new kinds of diseases—the bulk of the subsidies going into treatment of traditionally prevalent diseases like TB and water-borne diseases. This kind of partial coverage has pushed up healthcare spending of common Nepalis. The proposed policy will address this policy shortcoming which is “pushing well-off families to the verge of poverty while compelling the poor to remain incapacitated on their deathbeds.” A particularly laudatory aspect of the policy is that while Rs 2,000 per family per annum will be charged for those who can afford, those living below the poverty line would be exempted from any charges. The insurance holding family in turn will be entitled to yearly healthcare services worth up to Rs 50,000.
The government is planning to introduce the scheme as a pilot program in select areas on a voluntary basis within this fiscal year; the plan is to expand it throughout the country within five years of its lunch, when the program will be made mandatory for all families. There seems to be absolutely nothing wrong with the proposed policy. But again, many similar government initiatives in the past have foundered because of the lack of political will and rampant misuse of funds. Thus it will be important to maintain a high level of transparency on the operation of the proposed National Health Insurance Fund (a veritable Insurance Pool) that is to be set up under the Health Ministry.
This is all the more important because the Fund has been tasked with, among many other duties, mobilizing and allocating resources, developing healthcare packages, monitoring implementation of schemes and settling disputes. Managing such a diverse range of responsibilities will not be easy. After winding its way through the two houses of Congress, Obama’s healthcare legislation now sprawls over 2,700 pages. The biggest challenge in Nepal, as in the US, will be to make the healthcare bill as inclusive as possible while also minimizing loopholes that characterize any such ambitious legislation