National health insurance scheme finally ready for launch

ISLAMABAD: After some delays and initial hiccups, national health insurance scheme is being launched tomorrow (Thursday) in 23 districts of the country with an initial budget of Rs9 billion for around three million poor families.

Prime Minister Nawaz Sharif is expected to launch the scheme at a ceremony in Pak-China Friendship Centre on Thursday.

According to sources in the Ministry of National Health services, only the province of Khyber Pakhtunkhwa is resisting the implementation of the scheme in its territory while all other provinces have agreed to participate in the progarmme.

They added that major part of the scheme will be funded by the provinces which will pay the shortlisted insurance company State Life Insurance for the premium on the behalf of poor families.

The scheme is first of its kind in Pakistan and expected to benefit poor families whose daily income is less than Rs 200/- (US $ 2).

The target families will be provided with free of cost health insurance to access secondary as well as priority disease treatment without any financial obligations.

It will provide a blanket for cash-free treatment to the underprivileged for major diseases like cardiovascular diseases, Diabetes Mellitus, Burna and RTA (Life and limb saving treatment, implants, prosthesis), end stage renal diseases and dialysis, chronic infections (Hepatitis), organ failure (Hepatic, Renal, Cardiopulmonary) and cancer treatment (Chemo, Radio, Surgery).

The scheme titled “Prime Minister’s National Health Program” has been approved by ECNEC in May this year.

In the first phase the program would be implemented in 23 districts of Pakistan through State Life Insurance and both public and private hospitals will be engaged for the treatment of patients.

For the purpose of identifying and enrollee the beneficiaries database of Benazir Income Support Program (BISB) of people living below Proxi Mean test (PMT) of 32.5 is being used.

The Ministry of National Health Services has already has secured the database from BISP and handed over to National database and Registration Authority (NADRA) for the extraction of family and family tree from household database.

The premium on which State Life has secured top most ranking among its competitors is Rs: 1,299.98 per beneficiary family per year for the provision of secondary and priority disease treatment. This amount includes Rs: 999.99 for Secondary Care Services and Rs: 299.99 for Priority Disease Care.

State Life is tasked with the responsibility of hospital empanelment, package rates development, system expansion and beneficiary enrolment.

According to a senior official of the Ministry who is looking after the scheme, a Central Management Information System (CMIS) is being developed with the help of Nadra to monitor the status of program implementation in a real time.

“The CMIS will register all transactions carried out with the health cards and will populate a programmatic and financial dashboard. Doing so will provide a platform for the program managers, both at national and provincial level,and other stakeholders to provide supportive supervision to the insurance company, to minimize fraud and to closely monitor programmatic progress and processes,” said the official.  

In order to protect the financial interest of all stake holders, Equalization Reserve Fund (ERF) has been developed in the program which ensures recovery of unutilized premium during a contractual period by the government.

“As per this ERF, any unutilized premium and any profit earned by the insurance company on the insurance premium, shall be distributed between the insurance company and the government at a ratio of 5/95, 10/90 and 15/85 for first, second and third year responsively,” he added.

He said a poor family will get coverage worth Rs 300,000 per year for health care needs and if the need exceeds the limit the arrangement will be made to compensate the family with the help of Bait-ul-Mal and other institutions.

“This is first biggest healthcare initiative in the history of country,” he said adding that poor patients from Federal Capital will avail quality services in nine major hospitals of Islamabad.