Inflation does not only affect the cost of using tomatoes in the curry or air conditioning in summers. It also affects our choices when it comes to health. Can I procrastinate on this blood test? Must I go to a specialist? Why can’t I just look up my symptoms on Google and buy off-the-counter antibiotics? If the gall bladder pain is not killing me, let us delay that surgery. These questions are ones most citizens ponder over.

Pakistan has begun realising – both at the governmental and individual levels – that it is time to move towards the idea of health insurance. Not only is the government moving towards creating health insurance systems for underprivileged beneficiaries, but citizens too who have realised its worth and have begun looking at health insurance as saving that gives them a plan B in case of an illness. In addition, organisations especially in the corporate sector are now, more than ever, giving their employees the health insurance. Universal Health Coverage day fell on December12, an apt occasion to take a look at this emerging trend in Pakistan.

Health Insurance in the Public Sector

Sehat Sahulat is a flagship programme of the Ministry of National Health Services Regulations and Coordination, and participating provinces. It is a social health protection initiative, working to provide financial health protection to poor families in order to prevent them from falling into extreme poverty because of extra-ordinary health care expenditure. For doing so, each enrolled family is provided with free of cost health insurance to access indoor health care services from empanelled hospitals.

The Sehat Sahulat Programme started in January 2016. To date almost 5.9 million families have been enrolled; the programme has been implemented in more than 75 districts across Pakistan, Sehat Sahulat is a public sector project, funded by the Government of Pakistan (GoP) resources. The federal government is paying of the premium for ICT, GB, AJK, newly-merged districts of Khyber Pakhtunkhwa, district Tharparkar, and persons with disabilities, overseas Pakistani labourers, and members of the transgender community.

“Health is a human right; Universal Health Coverage (UHC) day which falls on December 12 is a very important day as it enables us to draw attention to the importance of health coverage. UHC is the most powerful policy lever through which we can achieve this,” says Dr Sania Nishtar, the special assistant to the prime minister on social protection and poverty alleviation. She explains that when one talks about health coverage, one has to be mindful that it refers to three things — geographic coverage, financial access to health care, and healthcare quality.

“It is important to realise that that health care costs are most impoverishing for people, and therefore it is critical to ensure financial access to healthcare so that people are not pushed into poverty as a result of healthcare expenditures and do not forego healthcare because they cannot pay,” she says, adding that social protection is a very important policy tool to enable financial access to healthcare.

“Within the Ehsaas umbrella, there are a number of interventions. One of those is Tahafuz which is the social protection arm of Ehsaas to ensure financial access to healthcare. We hope to begin operations in early 2020 and plan to scale it up nationally,” says Dr Nishtar.

“Health is a human right; Universal Health Coverage (UHC) day which falls on December 12 is a very important day as it enables us to draw attention to the importance of health coverage, says Dr Sania Nishtar

A representative of the Punjab Health Initiative Management Company (PHIMC) explained how the government-supported health insurance programme is working in the Punjab. While it is very much a health insurance setup, the beneficiaries do not have to pay anything; instead, the government pays the premium on their behalf. The coverage has recently been expanded from 13 to all, 36 districts of the Punjab.

There are some crucial exclusions when it comes to health coverage. Mental health treatment and dental treatment coverage for example are limited. However, expensive and long-term treatments like treatment for cancer, dialysis, and surgical procedures like bypass for cardiac disease are covered.

“Up till now government-supported health insurance programmes in Pakistan have only targeted underprivileged, citizens but over time we will have to include people from the middle-tier economic strata as well who can partially pay the insurance premiums,” said the PHIMC representative.

Health Insurance in the Private Sector

Dr Harris Shahzad, an eye surgeon and one of the directors at Shahzad Eye Hospital in Karachi, says that his hospital does get a lot of insurance-covered patients.

“The insurance usually does not cover OPD charges or investigations. They do cover surgical procedures, but give preference to ‘admission/inpatient’ rather than day care, which most eye care centres are. We usually do between 15 and 30 cases a month that have insurance-coverage for eye surgery,” says Shahzad. He says that insurance-covered patients have discounted rates at hospitals, and also cover major surgeries like treatment for a retinal detachment. “There’s always a cap on how much funds they can use depending on what company they are using or how much they have used on other specialties as well.

The emergence of a financial product supermarket like Smart Choice that enables people to compare between various insurance choices available and make informed decisions, shows that Pakistan is moving towards insurances. Health insurance is one of the key areas in this regard. Working with key players in the field of insurance, it is a one-stop shop for insurances. “For the longest time, Pakistanis were not aware of the difference between life insurance and health insurance. Awareness has increased. Comparative online platform have a lot to do with this,” says Majid Shah Bukhari, head of sales and operations at Smart Choice.

He says now people are also buying health insurance privately “for their peace of mind. It is easier to pay Rs 1,500 per month, for example, and know that you have treatment coverage up to Rs 500,000 for an unforeseen illness. In this era of inflation, illness of one family member can throw off your budgeting for years and leave you in debt. Health insurance saves you from that”.

Bukhari says that a lot of expats buy health insurance for their aging parents, and newlywed couples buy it to cover maternity expenses. There are also insurance plans available for illnesses like cancer.

The umbrella of choices for health insurance policies has become wider. “Shariah-compliant insurance policies (Takaful) are also available now, alongside conventional insurance,” says Bukhari.

“Health insurance provides a backup for unforeseen circumstances; it is like a compulsory saving,” says Dr Rukhsana Shahid, a general physician, who has been evaluating patients for fitness for life insurance policies since 1985 at Shahrukh Clinic which she founded.

“The cost of living has increased so we see fewer individuals buying insurance as they don’t want to spend that extra bit for insurance every month. The same applies to health insurance. However given the cost of medical care, it is inevitable that Pakistanis will have to move towards health insurance.”