The National Health Insurance Programme recently launched by the prime minister has raised questions about public health care
The National Health Insurance Programme of Prime Minister Nawaz Sharif that started from Islamabad is ultimately coming to different cities of the country. Initially, 23 districts had to be covered but towards the end of last year it was decided that 11 more districts would be included in the list.
As provincial governments have to make financial contribution to the programme, it has not taken root in Khyber Pakhtunkhwa (KP) and Sindh where the respective governments are not interested in joining it. Punjab, on the other hand, has understandably offered full support to the programme and expressed willingness to ultimately expand it to each and every district of the province.
Under this initiative the plan is to provide health insurance cover to poor families, earning Rs200 or less a day, so that they can get treated at hospitals designated under this programme. The selected beneficiaries are issued health cards that they shall produce when they visit these hospitals for their treatment or that of their family members covered under this scheme.
The beneficiaries have been selected using the data of Benazir Income Support Programme (BISP). If a person wants to check his eligibility for the programme, he can send his CNIC number at 8500 and get a reply within no time.
The State Life Insurance Company (SLIC) is providing health insurance in this case.
Those in the ruling party camp term this programme a great initiative that will enable the less-privileged citizens to get quality medical care with dignity. Their point is that as the hospitals treating them would get paid for their medical services by the insurance company, they would deal with them like their private customers and not ignore them like in the government sector hospitals. They also stress that under this programme, the subsidy will not be across-the-board, and reach only the deserving.
However, critics are of the view that instead of reforming the public healthcare system of the country, the government has engaged the private hospitals and decided to provide healthcare to selective population of the country. They claim that each and every citizen of the country is entitled to quality healthcare from the government, but are badly neglected. Basically, the health infrastructure is in a shambles.
There are apprehensions as well that this programme is meant to appease prospective voters in certain districts, and target swing vote that may help the PML-N in the next general elections.
A source in the Ministry of Health shares with TNS that mostly private hospitals and Combined Military Hospitals (CMHs) in different cities have been taken on board because the government hospitals lack capacity and financial autonomy required for this purpose. He explains a family having a Pakistan Sehat Card can use up to Rs50,000 for secondary health services and Rs250,000 for priority healthcare services in a year.
If the cost of treatment exceeds this limit more funds from Baitul Maal can be diverted.
The cash limit of Rs50,000 could be used for in-patient services (all medical and surgical procedures), emergency treatment requiring admission, maternity services (normal delivery/c-section), maternity consultancy (up to four times before and once after delivery), fractures/injuries, post-hospitalisation, local transportation cost of Rs350 (thrice per year) etc. The priority treatment cover of Rs250,000 could be used to cover expenses related to seven diseases/ailments, namely heart diseases (angioplasty/bypass), diabetes mellitus, burns and road traffic accidents (RTA) i.e. life and limb-saving treatment, implants, prosthetics, end stage kidney diseases/dialysis, chronic infections (Hepatitis/HIV), organ failure (liver, kidney, heart, lungs) and cancer (chemo and radiotherapy, surgery).
Economist Kaiser Bengali believes the national health insurance programme is a far-fetched one and launched without proper homework. "When the PPP government came into power in 2008, it established a health task force that was asked to work on a health insurance plan. I was vice chair of the task force and they invited CEOs of different insurance companies for consultation. Almost all of them advised against this, saying this will increase the demand of health services especially when the healthcare system does not have the capacity to meet the healthcare demand."
Bengali explains that when one knows one has a credit limit that has to be spent within a timeframe one is compelled to avail it. "There will be hardly anyone who will leave any of this limit unutilised," he adds.
He says it is also quite likely that certain hospitals present fake bills in connivance with cardholders without actually providing the services mentioned in the bills. "Has the government devised any mechanism to check this malpractice?" he questions.
He suggests that instead of opting for this programme, the government should focus on improving its health infrastructure, especially at the district and tehsil level. And spend more on preventive care than curative care."
Bengali says the government can save millions of people from diseases by simply providing them safe drinking water.
He also points out that though BISP is a very successful programme, there are some problems with data collection. "I personally know that in certain areas the surveys were manipulated by local elite and the influential to make locals eligible to receive cash transfers under this programme. If the non-deserving are getting Rs1,000 per month it will not be as big a loss as in case they are able to consume the limit of Rs300,000 for health cover," he concludes.
Bengali’s assertion is supported by the statement of Dr Faisal Rifaq, Technical Director of PM’s National Health Programme (PMNHP). Explaining the situation to the National Assembly Standing Committee on Planning and Development last year, he had said that this programme could not be launched in districts like Bahawalnagar in Punjab and Chaghi in Balochistan due to lack of health infrastructure despite poor health indicators in these areas.
In his response to TNS queries, Rifaq says, "PMNHP gives an option to the beneficiaries either to visit public healthcare facilities or private health care facilities on the panel. The programme, he says, does not exclude public health care facilities from empanellment and almost all autonomous health care facilities in public sector of focused districts and metropolitan cities are on panel in the programme. Provincial and federal government are working to improve the services delivery mechanism of public sector hospitals."
On the possibilities of overcharging, he says, "Hospitals on the panel have already submitted pre-negotiated package rates to the PMNHP and they cannot charge more than that. We have stopped many payments in which hospitals have charged more or tried to do tampering."
He explains that almost 85 per cent of family needs are being covered. "We have the support of Pakistan Bait ul Mal through which additional amount will be provided to the sick beneficiaries in emergency situation which covers almost all needs of families. There will still remain two to three per cent families who will consume even these limits for which the ministry is working with PM house to design a program specifically to cater to their needs."
Rifaq endorses the programme saying the world is moving towards an insurance based system and countries like Iran, India even Afghanistan have government-funded insurance programmes for the poor. Besides, he says, developed countries like Germany and others are leaders in this sector.