Fixing Health Insurance Flaws

As a person working in the insurance field for years now, I was alarmed to see the data of the Nepal Health Insurance Programme (NHIP) that shows the average claim amount nationwide stands at Rs 9,484 per person and Rs 20,294 per family — against premiums of just Rs 700 and Rs 3,500, respectively. This gives the claim ratio of 1355 per cent and 579.8 per cent considering average per person and average per family data, respectively. The common explanation blames low premiums, unpaid government subsidies, and hospital losses, all of which are true. But it treats the symptom as the disease. The real problem with NHIP is not the price but its design, i.e., the programme intended to cover the wrong kind of risk altogether.