A statement was issued by the Public Relations Directorate of the National Social Security Fund today, Thursday, stating: "At the end of last month, the Director General of the National Social Security Fund, Dr. Mohammed Karki, announced an increase in the Fund's contribution to the medication bill for chronic diseases (Generique) to 60% of the price set by the Ministry of Public Health, effective from February 26, 2024. Beneficiaries will have the option to access the Fund's electronic website to search for the medication name, price, and the Fund's contribution to it.
In this context, the Director General committed to adopting a similar procedure for the hospital bill, specifically for fixed surgical procedures. Based on the instructions given by Dr. Karki to the Directorate for Health and Maternity Insurance, lists of approved medical and surgical procedures have been established, including 3,200 surgical procedures. These have been studied to ensure the Fund's coverage is approximately 50% of the actual value of the fixed surgical work and will be implemented in an initial phase, with a review scheduled six months after implementation, if necessary.
Regarding internal processes within the Fund, and after consulting the technical committee and considering the amendments it proposed to the detailed account model for fixed surgical procedures, and following the Board of Directors’ decision No. 1276 made during its session No. 1030 dated February 8, 2024, with the approval of the supervisory authority by decision No. 12/1 dated February 12, 2024, Dr. Karki issued a memo dated March 21, 2024, numbered 746. This memo stipulated the adoption of the detailed account for fixed surgical procedures and the categorization of hospitals into three categories, while determining the prices for different fixed surgical procedures, effective from April 1, 2024. Consequently, the settlement, monitoring, and accounting of hospital bills that include fixed medical and surgical procedures will follow the operational process adopted by the Fund.
It’s noteworthy that the employees responsible for issuing the required approvals and the administrative monitors will inform the beneficiary of the applicable differences they are liable for, which remain after deducting the Fund's contribution according to the established procedures. Furthermore, in respect of the principle of transparency and the right to access information, lists of fixed medical and surgical procedures will be made available to beneficiaries so they can know the amount due, thereby reducing the margin for inflating hospital bills. These lists will be published on the Fund's interactive website.
Dr. Karki asserted that this step is the first in establishing a new health policy and a future system based on specific criteria that can expand and keep pace with inflation indicators in a scientific and legally stable framework. He also expressed hope that the hospitals contracted with the Fund would cooperate and assist in making this step a success, with the Fund's management establishing an immediate mechanism to process and pay bills related to fixed surgical procedures as quickly as possible."
