While the newly-launched health cards is a comprehensive healthcare package on paper, ground realities reveal the biggest flaw: the incompatibility between official and private rates for treatment
With a large number of people eligible for benefits of Naya Pakikstan Qaumi Sehat Card, the flagship programme of the Pakistan Tehreek-i-Insaf government, the lack of compatibility between the rates fixed by the government for treatment of some diseases and the charges at private hospitals is making the patients bear the brunt of an administrative anomaly.
Many who cannot afford private hospitals’ rates are being denied treatment. The ambitious programme is of course still in its infancy.
“While the rate for surgery to remove gallbladder stones has been fixed by the government at Rs 25,000, the hospital management demanded Rs 125,000 for surgery alone. Additionally, there were charges for room, doctor’s visits, tests and medicines,” says Najma Bibi, a housemaid from Township who visited a private hospital on Canal Road for the treatment of her daughter.
“We were shocked and returned without receiving the treatment,” she adds.
The pain of patients and the families coming from remote districts to the provincial capital for specialised treatment is even greater. A cancer patient, for instance, came all the way from Bahawalpur only to be denied chemotherapy at a private hospital in Lahore.
“We were asked to get pre-chemo tests done from a private lab before availing the chemotherapy for my son at the hospital against the Sehat Card,” says Abdul Ahad, an elderly man sitting at a roadside stall along with his family.
“Doctors in Bahawalpur referred us to Lahore for my son’s treatment, but we cannot afford the additional expenses and are therefore going back without treatment,” he says, despondent.
“The incompatibility of official rates and the market price of treatment, especially involving surgeries, points to the haste in rolling out Sehat Cards. It shows us that this was done prematurely and the required consensus among stakeholders was lacking. This has also exposed their inability to plug the loopholes in the system surfacing every now and then,” Prof Dr Ashraf Nizami, the president of the Lahore chapter of Pakistan Medical Association (PMA) tells The News on Sunday (TNS).
He says that the PMA had welcomed the mega initiative as an additional facility to offer quality healthcare to poor and marginalised populations, but “will resist it tooth and nail if it is launched with the objective of damaging or privatizing the existing public healthcare structure”.
A total of 651 hospitals – 148 in the public sector and 503 in the private sector – have been empanelled with a cumulative bed strength of 68,362 (36,182 in the public sector and 32,180 in the private sector) across the Punjab.
The Sehat Cards promise free of cost emergency and maternity services, surgical procedures, hospitalisation, free consultation and follow up, transportation coverage and in case of death burial support.
It is frequently stated that a Sehat Card offers coverage of up to Rs 1 million a year, yet it actually provides Rs 460,000 per family per year. The coverage is extendable to up to Rs1 million under special circumstances.
Under Package-I, priority disease treatment, all cardholders are allotted Rs 400,000 per family per year. This package covers treatment for certain specific types of diseases including heart disease, chronic diseases like tuberculosis, hepatitis-B and C, HIV, chronic liver disease, dialysis, burns and accidents, chemotherapy, surgery, radiotherapy for cancer, neurosurgical procedures and treatment for organ failure.
Under Package-II, secondary care treatment, the cardholders are eligible to receive up to Rs60,000 coverage per family per year. The package covers all types of medical and surgical illnesses and maternity services including C-section.
As of February 20, as many as 763,000 people have used the Sehat Card. Out of the number, 600,000 availed free treatment services from private hospitals for major diseases including dialysis, cataract, normal and Caesarian deliveries, hysterectomy, hernioplasty, appendectomy, oncology (chemo), coronary angiography, angioplasty/ CABG and chronic diseases. As a result, as per insurance company, an amount of Rs 120 million was diverted towards private hospitals as compared to just over Rs 20 million spent at government sector hospitals.
A senior professor, speaking on the condition of anonymity, expressed the apprehension that a parallel healthcare system might be detrimental to public sector hospitals in the long run. Explaining his point, he said, more and more patients from public sector hospitals will be referred to private sector with doctors in cahoots with private hospitals. In government hospitals too, he said, the doctors will prefer treating patients against Sehat Cards to claim their share, thus making patients or services not covered under Sehat Cards a low priority.
Currently, he said, three major hospitals in Lahore situated on Canal Road, Ferozepur Road and in Defence, were making money despite offering services only for cardiology, cardiac surgery and dialysis patients given their comparatively compatible rates under Sehat Cards.
“The smaller hospitals on the panel, which offer services for all diseases, are using substandard products such as sutures, medicines and test kits, which may result in complications among the patients and threaten their lives,” he says.
He believes that the Rs 440 billion Sehat Card project cannot substitute the public sector healthcare system.
Dr Salman Haseeb, a leader of Young Doctors’ Association, Punjab, says that although the Sehat Card provided relief to many cardiac patients who had had to endure long waits for angiography and bypass services at private hospitals, this has also resulted in an increase in unethical practices. He says in some cases intrusive treatments such as cardiac surgeries or insertion of stents were performed on patients not requiring them.
“Treatment through Sehat Cards may eventually lead to the privatisation of public sector hospitals,” he says. The training of medics, he says, has already been affected.
“Shaukat Khanum Memorial Cancer Hospital (SKMCH) was not empanelled for treatment under Sehat Cards, but experimentation in the public sector hospitals is considerd kosher,” he remarks.
This scribe learnt there have been instances of empanelled hospitals subletling services by referring unsuspecting poor patients to smaller hospitals and later charging on their own invoices to share the profits.
The complaints on Sehat Sahulat Program (SSP) portal also point to drawing of money from insurance companies without providing the treatment through alleged collusion between hospitals and card-holders. One of complainants objected to the distribution of Sehat Cards bearing the ruling party’s colours as national identity cards issued by NADRA could have served the purpose.
Meanwhile, some of the private institutions and companies that used to offer health insurance to their employees have withdrawn the facility.
“We have been deprived of our insurance facility of a complete health cover. What we are getting now is limited services only for certain ailmentsunder Sehat Cards,” laments Zeeshan Sohail, who works for a textile mill near Lahore.
Dr Ali Razzaque, the Punjab Health Initiative Management Company (PHIMC) CEO admits that the official rates for treatment of several diseases are incompatible with the fees and expenses charged in private hospitals. He says the government will review the rates and make them compatible with the market.
“We will review these rates annually to factor in the inflation every year,” he says.
“We have a proactive complaint redressal system,” he says, adding that the government will take strict action against all hospitals involved in unethical practices or demanding additional money from patients.
He says that the PHIMC has strict checks to ensure quality of services provided to the patients after carefully registering private hospitals on the recommendation of the Punjab Healthcare Commission (PHC). To a question about SKMCH empanelment for Sehat Cards, he says that the PHIMC and SKMCH have entered into an agreement in this regard.
“It will be announced soon,” he adds.
Dr Yasmin Rashid, the Punjab health minister, says that beneficiary satisfaction based on third party feedback survey is 98 percent.
“The nascent initiative will have teething problems. These will be resolved with the time. The people of Pakistan and the media must back this massive public health initiative in the interest of poor people,” she says.
She dismisses the apprehensions of Sehat Cards becoming a tool for privatisation. She says that four new hospitals will become operational by September and seven new hospitals will be set up in public sector next year.
“The Punjab government will further strengthen public sector hospitals in the province,” she adds.
The writer is a longform investigative journalist for over 15 years. He is currently associated with The News International. A fellow of East West Centre, he also contributes to national and foreign media outlets as a freelance journalist. Twitter: @AmerMalik3