LAHORE: Private hospitals are reaping the lion’s share of premiums in Punjab as the province rolls out a health insurance program meant to cover all residents, government data shows.
Healthcare is not universal in Pakistan and since the devolution of health to the provinces in 2011, each region is responsible for providing it on its own.
Punjab is the second Pakistani province to introduce health insurance to all residents after northwestern Khyber Pakhtunkhwa, which launched its Sehat Sahulat program last year.
In Punjab, health cards were first introduced in Sahiwal and Dera Ghazi Khan divisions in May this year. Up until now, over 30.8 million people of Punjab’s 110 million population have received health cards, according to data from the provincial government’s specialized health care department, which plans to cover the entire province’s population by the end of the year.
But while both government and private hospitals are included in the scheme, nearly all the medical help sought has been by private clinics: out of 425,848 hospital admissions, only 13,251 were at government facilities. The rest, or 97 percent, were at private hospitals and clinics.
The disproportion is not entirely due to individual choices of patients but a decision by local authorities to include more private entities in the medical insurance scheme rather than those run by the government.
“There are 289 hospitals on the panel in Punjab and the decision to register more private hospitals than public ones was taken after taking into consideration the number of public hospitals, their bed occupancy, infrastructure, machinery and other medical services,” Specialized Healthcare Secretary Amir Jan told Arab News this week.
He justified the decision citing better infrastructure at private clinics.
“Public hospitals are not infrastructurally strong and efficient enough to cater a large number of people, therefore, private sector hospitals have been engaged in this task,” he said.
Health cards have been unified with the national identity cards (CNICs) of Punjab residents in a digital database. Those with CNICs are now eligible to receive free-of-cost emergency services as well as treatment for cardiovascular disease, cancer, neurosurgical conditions, and diabetes.
A card holder can receive treatment costing up to Rs720,000 ($4,500) a year. In special cases, a further Rs360,000 can be allowed per family to complete the treatment.
Out-of-pocket expenditures account for nearly 60 percent of the total health expenditures in Pakistan, according to World Bank data. But now, said Dr. Salman Shah, an adviser on economic affairs and planning to the chief minister of Punjab, the health insurance program would take care of a lion’s share of these costs.
He justified the involvement of private health care providers with the need to expand services to rural areas.
“With the distribution of health cards to every district of Punjab by the end of this year, the need for expansion of hospitals will emerge in remote areas and therefore some incentives are being offered to private hospitals to expand their services,” Shah told Arab News.
“The government is not really efficient in making these kinds of investments. We see that the level of service and the level of management is much better if done by the private sector. The private sector can multiply the efforts of the government. So, it also forces the government hospitals to perform better.”
Yet, while the Punjab government calls the health coverage a “landmark” initiative, experts question its sustainability.
Economist Kaisar Bangali, who had served as an economic adviser to the Sindh government, said the government should use such programs to invest in the infrastructure of public hospitals and provide a competitive environment, rather than look toward private facilities for rescue.
“The private sector is benefitting the most,” he said, adding there have been complaints that private hospitals are also overcharging.
“The government should understand there is a huge potential for misuse of the facility. The government should also put in place a whole team to safeguard the system and minimize the misuse,” Bangali said.
For Shah, however, safeguards will be implemented by insurance companies once the rollout and the digital database is complete.
As premiums will be paid by the government to insurance companies, he said, the companies themselves will be monitoring the system and checking the eligibility of those seeking treatment.
If the hospitals participating in the health scheme fail to deliver, they will face consequences, Shah said.
“Any hospital, public or private, having failed to provide services to the people,” he said, “will be shut down.”
