Although the government’s health insurance programme has been expanded to all 77 districts of the country, only 20 percent of the total population has been covered by the scheme so far.

The programme, which aims to ensure universal access to quality health care services, was launched in mid-July 2015 from three districts—Baglung, Kailali and Ilam—as a pilot programme.

Officials at the Health Insurance Board, under the Ministry of Health and Population, concede that despite the rapid expansion of the scheme throughout the country in a short period, the percentage of the people involved in the scheme is very low.

Moreover, the dropout rate or renewal of the scheme is less than 50 percent.

“The number of people covered by the health insurance scheme is dismal,” said Dr Damodar Basaula, executive director of the Health Insurance Board. “Various factors are responsible for the dismal participation of the general public in the programme.”

According to data provided by the Board, 5,304,270 people—or 20.3 percent of the total population from 1,508,514 families—have signed up for the scheme.

Of the total people who registered their names for the service, 20,89,599 (39.39 percent) have availed of services under the scheme from 441 healthcare facilities—state-run, private or community-designated.

The government itself pays the insurance premium for certain groups–those living below the poverty line in 26 districts, elderly people above 70, family members of people living with HIV, disabled people and those suffering from leprosy, and multi-drug resistant tuberculosis. The government also provides a 50 percent discount on the annual premium paid by the family members of female community health volunteers.

Under the scheme, a family of up to five members has to pay Rs3,500 to get treatment, including medicine, check-up and counselling. Either one member of a single family with five members can use the insurance coverage worth Rs100,000 in a year or the amount can be divided among five members. Similarly, a family with more than five members has to add Rs700 per additional member for health insurance coverage of up to Rs200,000.

People covered by the insurance policy can avail themselves of health care services from the designated healthcare facilities upon presenting their identity cards. The expense incurred by the health facilities is reimbursed by the Health Insurance Board.

Experts say dismal participation of the general public and high dropout rate from the programme is a matter of concern.

Lack of awareness about the programme, government’s apathy to categorise people living below the poverty line in all districts, poor service delivery at the healthcare centres affiliated to the scheme, lack of medicines at hospital pharmacies, lack of trained health care providers throughout the year in the health facilities, and lack of equipment at health facilities are considered to be some of the major reasons for poor public response to the scheme.

“Chances of dropout from the scheme increases when people enrolled in the scheme do not need health care service in a particular year,” said Baburam Khanal, under secretary of the Board. “If the insurance policyholders do not need health care services in a particular year, they think their money has gone to waste.”

People enrolled in the scheme need to pay their insurance premium every year and even if they do not make use of the services they do not get any refund.

Doctors say it is the responsibility of the authorities concerned to ensure quality health care services, trained human resources at health facilities throughout the year and address all issues of the health insurance scheme to increase public participation in the scheme.

Officials said that even if the scheme is categorised as ‘health insurance’, it is a social security programme, which aims to ensure universal access to quality health care services.

“Even if everyone does not need the services, it is a relief for those who are in need and cannot spend Rs100,000-Rs200,000 on medical expenses,” added Khanal. “We have not been able to make people understand these aspects because it will come in handy when we or our family members need medical treatment.”