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Nepal China Health Insurance: Digital Health, Public Private Coverage, Fraud

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22nd April 2025, Kathmandu

Nepal-China health insurance talks highlight cooperation on digital tools, trust-building, and public-private health coverage models. The Nepalese delegation, led by Chairman Sharad Ojha, met with Deputy Director-General Zhang Hefeng from Sichuan in Chengdu, China.

Nepal-China Health Insurance

Key Focus Areas in Discussion

The discussions covered several critical topics. These included health insurance systems, policies, frameworks, and health protection. Both parties shared their perspectives on ensuring health insurance sustainability, improving payment systems, and offering comprehensive coverage. They also explored the role of the private sector in health insurance and the importance of providing easy access to services. Transparency in service delivery and increasing trust in insurance were also key points. Additionally, the use of digital technology to enhance health insurance effectiveness was discussed.

Sichuan’s Health Security System Explained

Zhang Hefeng shared details about Sichuan’s health security system. He explained it is divided into three phases. The first phase provides basic health care services. In the second phase, citizens pay a premium to access treatment for serious diseases. The third phase focuses on medical assistance, offering more comprehensive healthcare options.

Zhang emphasized that Sichuan’s health insurance system evolves based on the financial capacity of the institution and the government’s support. He noted that citizens are encouraged to buy health insurance for diseases not covered under the risk-free category. The government also offers essential medicines and basic medical services under public health security programs.

Tackling Fraud in Health Insurance

The issue of fraud was another important topic. Zhang discussed Sichuan’s efforts to combat fraudulent claims. He highlighted the internal controls in place to prevent false claims. Health institutions caught making fraudulent claims face severe penalties. This system aims to maintain integrity within the health insurance sector.

Private Sector’s Role in Health Insurance

The role of private insurance companies was also addressed. Zhang explained that private insurers in Sichuan offer a range of benefits. These benefits cater to the diverse needs of citizens. At the same time, the public health security system provides basic services, and private insurers offer additional coverage.

Nepal’s Health Insurance Policy Development

Chairman Sharad Ojha raised questions about the differences between public and private health insurance systems. He was interested in the sustainability of the public health system and how Sichuan’s experiences could inform Nepal’s health insurance policies. Ojha stated that Nepal would adopt lessons from Sichuan’s approach as it continues to develop its health insurance system.

Collaboration for Future Health Insurance Success

Both delegations agreed on the importance of cooperation between the public and private sectors. This partnership is crucial for creating sustainable health insurance systems. Ojha confirmed that the Nepal Insurance Authority would look closely at Sichuan’s policies and adapt them for Nepal.

The discussion also focused on improving citizen access to health services and removing barriers to coverage. Transparency and building public trust in insurance systems were identified as essential steps. Both sides agreed that digital tools would play a significant role in making health insurance more effective.

Delegation Participation

The Nepalese delegation included Chairman Sharad Ojha, Executive Director Sushil Dev Subedi, and Nepal’s Ambassador to China, Suresh Raut. The Chinese delegation featured key officials from Sichuan Health Security Administration, including Li Yajun, Li Rui, Wang Yiguo, and other senior officials.

This meeting is a significant step toward enhancing international collaboration in health insurance systems. It holds potential for strengthening Nepal’s health insurance framework by learning from Sichuan’s experience.

For more: Nepal-China Health Insurance


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