The government is learnt to have decided to make the beneficiaries of its health insurance scheme pay a certain percentage of the total treatment cost, claiming that the all-free scheme has encouraged them to seek unnecessary diagnostic tests. If it gets implemented, the co-payment plan will not just be an injustice to those who have already enrolled in the scheme, but will also act as a deterrent for those who want to join. Nearly 10 years after the scheme was first rolled out, the enrolment rate stands at a mere 16 percent. Despite the ever-burgeoning costs of medical care in private hospitals, people still prefer to pay the premium rather than go to government hospitals as the latter are too mismanaged. Apart from managing them well, the way to bring the patients back to the government hospital is to institute a cost-effective and well-functioning insurance scheme.

The existing scheme, which charges Rs3,500 a year for a family of five, seems to be working well for many households across the country. Families enrolled in this scheme get a yearly coverage of Rs100,000. The scheme has several advantages, depending on which hospital is accessed. Dhulikhel Hospital in Kavre is, for instance, representative of the hospitals that have implemented the scheme well. The beneficiaries only have to show up with the insurance card, and their diagnosis and prognosis are taken care of without hassles through the scheme, albeit within its limits. In being efficient and cost-effective, the scheme provides the beneficiaries a sense of dignity as they do not have to face the hassle of delayed reimbursement and unnecessary scrutiny, as is the case with some private insurers.

Despite the positive sides, so few families are enrolled in the scheme due to its inherent flaws. For one, you can avail services only at your primary hospital, which is determined at the time of enrolment for the scheme. The problem with this provision is that the beneficiaries who need medical care when they are away from their primary hospitals cannot use the insurance. They have to go back to the primary hospital and get a referral from there—which is a nearly impossible task. No patient would want to travel back to the primary hospital for a referral when they are sick and need immediate medical care. The universality of the “universal” health care system that the government harps on while publicising this scheme is, therefore, missing here. And this is where the authorities should look into.

However, government officials, staying true to typical bureaucratic arrogance, keep behaving as if they are paying for people’s insurance from their own pockets. What else explains their arrogance as they say the beneficiaries seek unnecessary diagnostic tests? In a society where doctors have unquestionable agency, patients usually have no say in the course of treatment. The cases of patients seeking to dictate diagnosis are few, and this cannot be an excuse to impose undue fees on the beneficiaries.

If you cannot improve it, don’t make it any worse! This is the mantra the Pushpa Kamal Dahal government should follow as it struggles to prove its relevance a year after its formation. Having failed to stop the exodus of the people, alleviate the frustration of the unemployed youth or improve the economic situation, the government is trying hard to show progress. However, at such a critical point, it also puts the cart before the horse by deciding to burden the people with a needless co-payment system in order to access vital health insurance.