25 March, Kathmandu. Time: Wednesday morning at 10 am. Location: Nepal Administrative Institute, Jawalakhel, Lalitpur.

With the 10th anniversary of the start of the health insurance program, the insurance board had a program to publicize important achievements.

The program started on time. The health secretary and director general of the department, additional health secretary and others were on the stage. Health Secretary Dilliram Sharma was the special guest.

Executive Director of the Board Dr. Krishna Prasad Paudel presented the achievements and some problems in insurance in 10 years.

Then it was the turn of the Additional Health Secretary to speak. The middle chair was vacated by moving the guest who was sitting on the stage to another chair. At the same time, Minister of Labour, Health and Social Security Deepak Kumar Shah appeared on the stage.

Shah was invited as the chief guest. He reached about 30 minutes after the program started. After a while, the announcer asked Shah to speak.

Sah started his speech by saying that he does not know much about the health sector and needs to learn from the health workers and experts present. Minister Sah, who spoke for about 15 minutes, objected to the working style of the Ministry of Health and its employees.

While speaking, he blamed the Ministry of Health, the Health Insurance Board, hospitals and health workers and expressed his dissatisfaction with the government’s program.

While speaking, Shah said that he would not come to give a speech calling himself a ‘new leader’. “I am a new leader, I don’t feel like giving a speech,” he started his statement.

As soon as he said this, the whole hall burst into laughter. His speech, which started after that, made many people present at the event uncomfortable.

Minister Shah gradually began to present himself in an angry style. He started accusing various agencies saying that the condition of the health insurance program is very weak.

According to Shah, the health insurance system has now reached a pathetic state. He said that the responsibility of this is not limited to one organization but is shared among the Ministry of Health, Health Insurance Board, health institutions and health workers.

Mentioning that the constitution of Nepal guarantees health services to the citizens as a fundamental right, he said that all agencies should cooperate to make the services effective. But he said that the current health insurance system is far away from that goal.

Shah said that there is currently a huge financial imbalance in the health insurance program. According to him, the expenses have increased significantly compared to the amount collected from the contributions.

‘About 3 to 4 billion rupees is raised only from contributions. But the cost reaches 28 to 30 billion,” he said. “How will the government pay? How to do it?’

Minister Sah also accused the hospitals in the program. He commented that there is a tendency for hospitals to conduct unnecessary tests and spend all the money of the person while taking services from insurance. He called it an example of ‘adverse selection’ and ‘moral hazard’ and claimed that there is a serious problem in the insurance system.

He said that the reason for the failure of the health insurance program was not financial lack but management and structural weakness.

Labor Minister Sah commented that the Health Insurance Board and the Ministry of Health should be self-critical. ‘I suggest the Health Insurance Board and Health Ministry employees to self-criticize,’ Minister Shah said, ‘Friends of the Health Ministry say health insurance separately. But you decide yourself. The insurance board has to run under the pressure of the joint secretary.’

After saying this, laughter spread again in the hall. But the anger in the minister’s speech was increasing. He targeted the Ministry of Health and said, ‘The Ministry of Health has the biggest role in being so weak and miserable.’

Minister Shah said, ‘First of all, I request the Ministry of Health to be honest.’

He added another reference. Saying that the journalist has made him more popular, Sah continued, ‘Nowadays I am becoming very famous. I am a person who lives in hiding, but my name is coming everywhere.’

After his comments like this, there was laughter in the hall. But the officials of the Ministry of Health sitting on the stage were looking at each other’s faces.

During his speech, Minister Shah expressed his strong dissatisfaction with the administrative structure and bureaucracy of the Ministry of Health in particular.

After becoming a minister, he remarked that the bureaucracy was more responsible than the leader for the deterioration of the country.

“At first, when I was a citizen, I thought that the leader ruined the country, but when I became a minister, I realized that the bureaucracy has rotated the leader,” Minister Shah said, “Stop rotating the leader.”

Not only this, he also questioned the decision-making process of the Health Insurance Board.

They began to accuse saying ‘how to leave the board too’. He alleged that the role of the board members was limited to signing formalities.

Some people linked Minister Shah’s comments on the board to another controversy. His wife Junu Shrestha was a member of the Health Insurance Board. He was appointed as a board member by the then Health Minister Mohan Bahadur Basnet in December 2080. But after continuously absenting himself from the meeting, the board sent a letter to the ministry to proceed with the process of suspension.

Later, the issue of him returning to the board using political access also came into controversy. She again attended the recent board meeting.

Some people explained the criticism of the board’s decision-making process in Minister Shah’s speech by linking it to this controversy.

Minister Shah raised a question about the role of responsibility on the chairman and executive director. Minister Shah gave instructions and said, ‘Chairman and executive director of the board should stop acting as rubber stamps for the members.’

He instructed to re-review the structure and responsibility system of the board.

He claimed that the arrangement of the board members being responsible for decisions is not clear and some decisions are made on different basis than the interest of 30 million citizens.

Sah pointed out the need to integrate many schemes in the health insurance system saying that they are operating separately. He said that the system will be effective only if the social security fund, army-police and other institutional health service schemes are brought into one structure.

Sah claimed that the health facility scheme of the Social Security Fund, which is operated under the Ministry of Labour, is also ready to be brought into an integrated structure.

He commented that the ‘benefit package’ of health insurance has also been made too expensive and said that it should be re-reviewed. He alleged that the current system was designed to benefit the hospital but weaken the insurance board.

Minister Sah said to the employees of the insurance board, ‘There is no point in making excuses that the government has not given the money and that only the blame will be imposed.’

He satirized the board and said, ‘What are you doing sir, 30 lakhs (target category) have been given free. You didn’t add it. It is connected by itself.’

While minister Sah was making accusations, the health ministry secretary, additional secretary and the officials of the board were speaking.

According to a senior official of the Ministry of Health present at the event, the minister’s statement surprised many. The employee says, ‘They didn’t care what to say. The program was to publicize the achievements of insurance, but he mainly expressed his anger on the problems and employees.

According to an official of the board, the reason for inviting Minister Shah as the chief guest was also special. Having a background in public health and the expectation that coordination of the insurance system with the Social Security Fund under the Ministry of Labor would be possible, he was invited.

However, the official says, ‘I had no idea that he would speak like this. The program ended in a controversy rather than an achievement.’