Most health care in Nepal is paid out-of-pocket. Catastrophic health care expenditures are the major cause of indebtedness and poverty of many Nepali families.
Twenty-year-old Shital Rai was all smiles that morning during medical rounds. Three days ago in Khotang in eastern Nepal, he had high fever and rapidly became somnolent. His relatives, fearing the worst helicoptered him to Patan Hospital where he was diagnosed with meningitis, treatment was promptly instituted, and he recovered quikly. If he had been in Khotang without treatment, his condition may well have deteriorated and he might have died. His family paid about Rs 1,00,000 for the helicopter ride and about Rs 10,000 for hospital treatment.
Fifty-five-year old Kanchi Maharjan had been feeling nauseated and drowsy for weeks until her family took her to a hospital where she was diagnosed with chronic renal failure. Hemodialysis (cleaning the impurities in the blood) was begun, and she became alert and well-oriented. The change was dramatic, but the improvement would only be temporary if she did not continue to have at least two dialysis sessions a week at a cost of Rs 20,000.
Taxi driver, Kumar Babu, 55, suffered a heart attack while driving, but after the diagnosis was made, he had no money left to pay for a stent placement in his blocked heart vessels which would cost Rs 1,00,000.
What is to be done to deal with these practical health problems in Nepal so that the patient and his or her family are not helpless at the time of need? Here are some possible solutions:
The entire population should be covered by a universal health insurance package with financing from a combination of public, employer, and private sources. Cost-effective interventions should include health promotion and disease prevention. Government spending on health should be increased. A comprehensive health information and surveillance system needs to be instituted. A national network of pharmacies for generic, low-cost drugs needs to be available. Consensus-building mechanisms through public debates involving government, civil society, health professionals, academia, private sector, and the media need to be promoted.
All arduous tasks. But if we don't start now many individual Nepali families will continue to suffer and be emotionally torn between financial survival and seeking debt to pay the bills for a loved one with a catastrophic illness.