Monday September 20, 2021

Flawed reforms

July 31, 2021

The PTI government in Khyber Pakhtunkhwa has been claiming reforms in major sectors like education, health, and the police since taking charge of the provincial government in 2013. However, the reality is anything but. This article will highlight anomalies in the health sector.

To streamline and bring forth efficiencies, along with the Medical Training Institute (MTI) programme enacted in 2015, the Sehat Insaf Card (SIC) public insurance programme was launched.

The MTI replaced the previous health system without assessing the ground realities and testing the changes in parallel with the prevailing system to gauge its effectiveness. No one can argue that the previous system didn’t have flaws but the approach toward the change was even more flawed. Instead of enacting changes across the board, they should have been first tested in a section of a hospital or at a hospital, and then, with lessons learnt and keeping in view the cost and service to the public, only effective changes should have been implemented.

A stark example of the MTI fiasco is the ensuing crisis in the public hospitals of the province. Except for Lady Reading Hospital (LRH) at Peshawar (where the programme has had partial traction), none of the other public hospitals in the city or province has been able to implement the MTI in its true spirit. Many new positions in the administrative area of the hospitals were introduced under the programme with pays as high as four times the previous pays (directors that were getting about Rs100,000 were paid Rs500,000) but patient services continued to plummet.

Another example of the flaw in the MTI is Institute Based Private Practice (IBP), where public hospital doctors needed to practice in the hospital with assigned patient fees. However, to date, after six years of implementing the program, most of the doctors are said to still maintain their private practice outside the hospital. Moreover, since junior doctors were promoted without the needed expertise, many senior doctors, especially in the past three years, have abdicated public hospitals, resulting in further weakening of public healthcare.

Equally, if not more, alarming is the SIC insurance programme introduced in the province and now extended to Punjab. Currently, under the programme, all KP dwellers and their families that hold a valid CNIC are automatically insured, with no deductible amount, for in-patient health care.

Without fulfilling the basis of a welfare state where taxes are collected generally through industries and the private sector, the KP government has been running the SIC with a 100 percent subsidy. On behalf of the public, payment is made to a private insurance company(ies) that renders the services. There are a few basic issues with this approach. First, since the SIC was launched without optimizing the health sector, it encourages patients to opt for better services that can only be delivered by private hospitals. Second, the SIC doesn’t support out-patient services which have become more expensive with high sector salaries. Third, since the SIC is completely subsidized and there has been a budget deficit, the subsidy amount that’s being paid for about 50 million people of KP will further burden the public through loans, inflation, and taxation.

Due to the lack of information, credible data is not accessible for payments made to insurance companies. However, even if they were to pay Rs500-1000 per person per month, and if one accounts for 30 percent of the population, the cost to the public could be as high as Rs7.5 to Rs15 billion a month.

This substantial amount of subsidy is being extended without any value addition, meaning that it doesn’t render any capacity building and generally to a larger scale that’s been a problem in Pakistan, where governments extend subsidies for short-term gain without realizing its perils in the long term. This issue is more prevalent from the SIC perspective, where a huge amount is being doled out without implementing programmes to improve people’s health, reducing the cost of healthcare, setting and beefing up health centers at the union council level, and overall improving the health sector’s infrastructure.

Furthermore, the majority of patients visit public hospitals for outpatient services. According to data, LRH receives about ten thousand patients a day of which about five hundred to a thousand may require in-patient care. The issue that’s been escalating in the health sector due to the programmes is that the cost of outpatient services has skyrocketed, where people are having to pay for charges from parking, emergency care to doctor visits at a considerably higher rate. This has basically made healthcare unreachable for the poor.

The writer is a finance/economics professional.

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