Starting January 15, people enrolled in the government’s health insurance scheme will have to pay a certain percentage of their treatment cost out of their pockets, as the authorities are preparing to enforce a co-payment system.

The move aims to discourage insured people from seeking unnecessary tests, officials said.

“The copayment scheme will be applicable to all hospitals that have been implementing the government’s health insurance scheme,” said Om Kumari Kandel, information officer at the Health Insurance Board under the Ministry of Health and Population. “We have not yet finalised the details regarding the services for which insured people will be required to contribute payments or what percentage [of the cost] they will have to bear, but insured people will have to pay for treatments once the new provision is enforced.”

Until now, insured people and their families need not pay any charges to the health facilities for taking services of up to Rs100,000. Officials said they plan to charge 10 percent of the total treatment cost to insured patients on specific services.

The health insurance programme has reached 750 local units of the country’s 77 districts. However, less than 16 percent of the total population has been covered by the scheme so far.

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

Officials at the Board concede that despite the rapid expansion of the scheme throughout the country in a short period, the percentage of the people who have enrolled in the scheme is low.

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

Officials say various factors are responsible for the dismal participation of the general public in the programme.

The government itself pays the insurance premium for some 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 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 worth an additional Rs20,000.

People covered by the insurance policy can avail themselves of healthcare 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 the dismal participation of the general public and the high dropout rate from the programme is a matter of concern.

Lack of awareness of the programme, government’s apathy for categorising 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 healthcare providers throughout the year in the health facilities, and insufficient 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 programme increase when people enrolled in the scheme do not need health care service in a particular year. If the insurance policyholders do not need health care services that 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, train human resources at health facilities throughout the country and address all issues of the health insurance scheme to increase public participation in the scheme.