care services
care services

Sustainable health insurance for all

Article 35 of the Constitution of Nepal guarantees the right of citizens to free basic health services from the state. However, in practice, health care is one of the most commercialized sectors in Nepal. There are abundant private hospitals with opulent facilities in Kathmandu and other urban areas, but healthcare facilities are still rudimentary in rural areas. According to a 2021 data from the Ministry of Health and Population, there were 110 hospitals, 10 health centers, 3,789 health posts and 3,176 sub-health posts in Nepal. The frequency of physicians is one per 18,400 people. Nepal is among the countries with the lowest global health care index—ranking 107th globally, and 6th among eight South Asian countries. The main reason for this is the inefficiently implemented health care policy over the years. Apart from that, the unbearable cost of medical services in private and inadequate facilities in government hospitals is also the reason that is alienating citizens from the constitutionally guaranteed right to basic health care services.

The manifestos of all major political parties include the implementation of ubiquitous access to health care services once they form the government. Unfortunately, the promises are broken once the respective parties command the power to operate state machinery. Since the promulgation of the new constitution in 2015, minimal progress has been achieved in this sector; no sustainable policy has been drafted, and no effective homework has been done to materialize the mandatory constitutional directive.

The foremost requirement for ubiquitous access to health care is its cost-effectiveness. If the service is too costly, as it is at the moment, a large section of the people is deprived of fundamental rights. On the contrary, the cost of health service commodities, including medicines and hospital equipment, is skyrocketing globally. Within the present health care setup, it is

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Reports: 12 Oregon health insurance companies failed to fully comply with the Reproductive Health Equity Act

SALEM, Ore. (KTVZ) – All 12 health insurance companies in the individual, small group, and large group markets in Oregon failed to fully comply with the Reproductive Health Equity Act at varying levels, according to reports released Wednesday by the Oregon Department of Consumer and Business Services ‘Division of Financial Regulation.

The agency found that most noncompliance involved improperly charging copays, coinsurance, and deductibles or failing to cover mandated benefits.

The division examined Aetna Life Insurance Company, BridgeSpan Health Company, Cigna Health and Life Insurance Company, HealthNet Health Plan of Oregon, Kaiser Foundation Health Plan of the Northwest, Moda Health Plan, PacificSource Health Plans, Providence Health Plan, Regence BlueCross BlueShield of Oregon , Samaritan Health Plans, UnitedHealthcare Insurance Company, and UnitedHealthcare of Oregon.

The examinations found that each of the 12 insurers failed to pay all eligible claims according to RHEA requirements. They applied copays, coinsurance, and deductibles, which are prohibited under RHEA for reproductive health and preventive care services. In some cases, insurers improperly denied claims for RHEA covered services.

In addition, the report found that three insurers – Aetna, BridgeSpan, and Regence – failed to cover certain types of contraceptives or applied improper limitations in the amount or timing of when a member could refill a prescription.

Finally, examiners found that Cigna, HealthNet, Kaiser, and Samaritan each failed to properly resolve all consumer complaints and maintain adequate records demonstrating that they timely and adequately resolved member complaints, appeals, and complaints.

“RHEA is a critically important tool in the state’s effort to remove barriers to reproductive health care,” said Oregon Insurance Commissioner Andrew Stolfi, who is also the DCBS director. “As with every law, our insurers have an obligation to fully and timely implement each aspect of RHEA across all of their systems. It is disappointing to see

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