Nepali Times
Life Times
Universal health insurance


Most health care in Nepal is paid out-of-pocket. Catastrophic health care expenditures are the major cause of indebtedness and poverty of many Nepali families.

Twenty-year-old Shital Rai was all smiles that morning during medical rounds. Three days ago in Khotang in eastern Nepal, he had high fever and rapidly became somnolent. His relatives, fearing the worst helicoptered him to Patan Hospital where he was diagnosed with meningitis, treatment was promptly instituted, and he recovered quikly. If he had been in Khotang without treatment, his condition may well have deteriorated and he might have died. His family paid about Rs 1,00,000 for the helicopter ride and about Rs 10,000 for hospital treatment.

Fifty-five-year old Kanchi Maharjan had been feeling nauseated and drowsy for weeks until her family took her to a hospital where she was diagnosed with chronic renal failure. Hemodialysis (cleaning the impurities in the blood) was begun, and she became alert and well-oriented. The change was dramatic, but the improvement would only be temporary if she did not continue to have at least two dialysis sessions a week at a cost of Rs 20,000.

Taxi driver, Kumar Babu, 55, suffered a heart attack while driving, but after the diagnosis was made, he had no money left to pay for a stent placement in his blocked heart vessels which would cost Rs 1,00,000.

What is to be done to deal with these practical health problems in Nepal so that the patient and his or her family are not helpless at the time of need? Here are some possible solutions:

The entire population should be covered by a universal health insurance package with financing from a combination of public, employer, and private sources. Cost-effective interventions should include health promotion and disease prevention. Government spending on health should be increased. A comprehensive health information and surveillance system needs to be instituted. A national network of pharmacies for generic, low-cost drugs needs to be available. Consensus-building mechanisms through public debates involving government, civil society, health professionals, academia, private sector, and the media need to be promoted.

All arduous tasks. But if we don't start now many individual Nepali families will continue to suffer and be emotionally torn between financial survival and seeking debt to pay the bills for a loved one with a catastrophic illness.

1. Niraj Shrestha
I know this will be very tough to implement, Universal Health Insurance, but someone should start to study how we can implement once we have stable government. We at least should try in village level how we can work out this concept. Happy to see someone is thinking this concept. There is always pros and cons but for us its better. 

2. Narayan Bhusal MD
Staying in philippines and get to know the health system here for many year, I have been thinking about it since long time. Here they have phil- Health which is a government health insurance system.This program is very much  suited for third world county like our. Pls visit this site. Many similarity we have in terms of socioeconomic status and health problem.

3. Anoop Singh Gurung, MPH
This is truly desirable in any developing country, but there are two burning points to be noted amongst many. The first one being a gradual development of such programs and not a one established in haste, because a lot of homework and preparation needs to be done at par. The other is that such schemes are mostly pro-poor and looking at the situation of Nepal, the problem of health care is not financial mostly (because it is out of pocket for everyone), but rather a concern of accessibility. So, the establishment of the scheme does not guarantee maximum utilisation by the poor or the ones who do not have access. Much to think about rather than just to desire!!

4. Madan Chaulagain

There are major complexities about implementing this and in our country this is a very low priority. So this is desirable and should hope for such programs in Nepal in about 100 years later when we see new youthful and patriotic politicians.

5. Supriya Serchan

It is very impressive to see these wonderful and thoughtful ideas that people are thinking and trying to implement. It is difficult to see them come to fruition especially when government is not well established and functional enough to serve to the needs of its citizen. As people struggle with basic necessities such as water, food, and shelter on daily basis, factors and vectors that impact their health and environment take back seat. Factors such as pollution and environmental degradation tend to get neglected a lot. I had a chance to notice this first-hand, when I visited my birth-country after living abroad for five years. Needless to say, I was torn apart to see environmental degradation and its negative health impact on people living in closed knit communities.

Health is wealth and it dictates the directionality of a country. Living standards, economic viability, development of any country are directly an outcome of health and well-being of its population. If significant population is unhealthy then the country itself will be in loss with regards to manpower, wisdom, and knowledgeable people. We should preserve the most of what we have today to guide our future. Health is indeed a human right and it is thoroughly explained in article 25 of the universal declaration of Human Right. According to the article, "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control".




(11 JAN 2013 - 17 JAN 2013)