A question of efficiency

While the Sehat Card is an excellent way to universalise health care – provided that there is efficient implementation and planning – a solution to the problem also lies in prevention of disease and improved facilities and management at hospitals

Health provision to the masses is a responsibility of both the federal government and the provincial governments. Currently, the constitution does not promise free healthcare to the general public. However, it does take on the responsibility of providing basic health facilities to the people. These include immunisation for preventable infections, obstetrics, neo natal facilities, emergency management, infectious disease control and medical or surgical diagnosis.

The government of Pakistan has decided to provide universal health care to all its citizens by utilising all available public and private hospitals. The programme was introduced on January 15, 2016, under the PM’s national health programme. A similar concept has been initiated by the PTI government under its Sehat Sahulat Programme. This programme pays a fixed premium per family a year thereby providing each family a health coverage package.

In the last budget the government of the Punjab allocated Rs 12 billion for the Sehat Insaf Card. The MTI (Medical Training Institutions) Act has been passed by the provincial governments of the Punjab and Khyber Pakhtunkhwa to make public hospitals a business enterprise so that they can be on the panel of Sehat Sahulat Cards. This way the government is trying to reduce its burden of running and optimising health establishments and their human resources. While this may actually reduce the burden on the government, it is essential that the government continues to spend on scientific and logistical development of hospitals across the board. Even with insured health service provision, the medical facilities available at most public hospitals and many private hospitals are insufficient to deal with complicated cases. This is clear from the fact that only 295 ventilators are currently available in the capital with an overwhelming occupancy rate. Hence, while the Sehat Sahulat Programme provides health care currently to 6 million living under the poverty line, this is certainly not sufficient and needs urgent government attention.

Moreover, the human resource at public hospitals is to be denied the career civil servant status and given contract employment under the new scheme. Health provision to the masses through insurance cards by the government helps align both public and private health establishments. On paper, this is a very good concept as it reduces the burden on the government. Instead of spending billions on development of new hospitals the amount can be spent on actually providing the care available commercially.

However, the implementation of this scheme needs more atention. Currently the scheme promises both primary and tertiary care to patients. The services provided and cost of the primary and tertiary care vary greatly. It must be noted that a patient visiting a hospital still needs diagnosis and is not aware whether there will be a need for primary or tertiary health facilities. Hence, an efficient system must be implemented in private and especially public hospitals which codes these procedures specifically and is able to increase the budget provided to the patient according to the facilities required. In the few private hospitals where the health card is currently being used the hospitals have to wait for government approvals. Complicated and costly approvals might leave the patients waiting unnecessarily.

Currently the Sahulat Card facility covers only in-patient treatments. This means that only patients who are admitted to hospitals are able to utilise their Sehat Sahulat cards. Out-patients visiting hospitals for a checkup have not been included in the ambit of the Sehat Card. There is a need to provide similar services for families to visit physicians in order to take advantage of such facilities.

The programme also lacks recognition of the fact that hospitals and treatments available vary from region to region. Currently, it is a blanket policy for all hospitals and regions. This might prevent a large number of private hospitals with advanced medical facilities from joining in. The rate list should be rationalised and regionalised in accordance with the categories of hospitals and the nature of the procedures. Some district level hospitals might not even have the facilities to charge patients an amount of Rs 70,000 or more which the Sehat Card provides. Providing all hospitals regardless of the facilities available with the same amount per patient might create room for corruption.

While the Sehat Card is an excellent way to universalise health care – provided that there is efficient implementation and planning – a solution to the problem also lies in prevention of disease and improved facilities and management at hospitals. The government should also take measures to ensure the provision of clean drinking water, provide sufficient food and vaccination facilities to the population to achieve universal health care in the true sense.

The author is an orthopedic surgeon and the CEO of the Orthopedic Medical Complex (OMC) in Lahore. He is also a member of the provincial assembly and the standing committee on health and medical education

A question of efficiency