Health Card co-payment raised by 10pc

LAHORE:The Punjab government has further increased co-payment by 10% under Sehat Sahulat Programme thus equalising the government’s and patient’s contribution to half each for procedures in private sector.

In what is termed as a long-term financial sustainability of the programme Phase-III / Universal Health Insurance, also known as the Health Card, in the province, the Punjab government revised the percentage of claim co-payment from 40% to 50% for all applicable procedures from tomorrow (Tuesday), in all private empanelled hospitals.

Punjab Health Initiative Management Company (PHIMC), in continuation to the intervention of claims co-payment across various procedures at private empanelled hospitals, directed State Life Insurance Corporation of Pakistan (SLIC) to take actions to ensure the timely implementation of the revisions in co-payment percentage.

The PHIMC, on the recommendation of Standing Committee of the Cabinet on Universal Health Insurance, first, imposed 30% co-payment on 01.09.2023, which was later raised to 40% for all procedures being performed at private empanelled hospitals with effect from 15.09.2023.

In previous notification, dated 12.09.2023, PHIMC exempted various services from co-payment, including oncology, dialysis, ICU / CCU / NlCU / HDU / Ventilator medical, thalassemia, orthopedics/neuro trauma cases only. The exemption included all emergency, life-threatening cases as well as to the beneficiaries aged 65 years and above except for cardiology-related treatments.

However, the latest notification, dated 10.01.2024, does not indicate any such exemptions. PHIMC CEO Dr Ali Razzaque claimed that PHIMC imposed 50pc co-payment by the patients against negotiated rates to discourage the misuse of the free treatment facility in private sector, it fails to reap dividends in the public sector as the monthly earning of Punjab’s teaching hospitals on Health Card Scheme considerably dropped despite payment of premium for scheduled procedures. The SHC&MED statistics revealed that the Health Card claims could not exceed Rs1.5 billion per month at each teaching hospital during in the last six months of previous year.

While the Punjab govt paid a premium of Rs100 billion to SLIC, the govt hospitals were supposed to generate revenue through Health Card. The hospitals were supposed to generate Rs40 billion annually, but they failed due to their inability to perform required number of surgeries by optimally discharging services through Health Card. Tertiary care teaching hospitals registered, at least, Rs1bn loss per month by not doing enough procedures under Health Card despite payment of premium of Rs100bn for the same by the Punjab govt.

Consequently, the hospitals are demanding additional budgets from health dept, but Finance Dept showed reluctance. Resultantly, the patients are suffering in hospitals.

Talking to The News, the caretaker Health Minister Dr Javed Akram said that the Punjab government had implemented effective policies which reduced its liabilities to Rs45 billion per year in comparison to previous government’s outstanding sum of Rs150 billion per annum owed to the insurance company; the govt had reversed the previous ratio of share of 70:30 to doctors and hospitals respectively, which had considerably improved services in public sector hospitals.

When asked about paucity of funds in hospitals, he said the government had also increased budget for purchase of medicines in public sector hospitals.