When Cost-Cutting Threatens Universal Health Coverage

The Constitution has guaranteed citizens’ right to health. In a country with a democratic system of governance like ours, ordinary citizens must be ensured access, particularly to the rights to education and health. When these two rights are secured, people’s lives become easier. To ensure the right to health, the general public must be connected to health insurance. In recent years, the government has actively implemented the health insurance programme. By bringing many people under insurance coverage, it has made access to treatment easier. Even citizens with little or no income are able to receive certain treatments designated by the state through this scheme. However, the decision made by the Health Insurance Board on January 8 to provide outpatient health services worth only Rs 25,000 per family per year has not been considered reasonable. This means that in a family of five members, services worth only Rs 5,000 per person would be available. The provision, which will come into effect from February 13, is likely to place an additional burden on the general public. Not everyone falls ill at the same time, nor does everyone seek treatment simultaneously. Even so, when treatment is required, Rs 25,000 is insufficient. In such circumstances, the limit set for outpatient services is inappropriate. Apart from outpatient services, under the current system, insurance coverage of Rs 200,000 per person is available for eight types of critical illnesses. The Board has introduced the new arrangement after revising service fees, stating that it aims to reduce financial pressure on the Board and ensure more effective utilisation by insured individuals. Patients will be able to spend up to Rs 75,000 for additional services when admitted to hospital wards.