Written by: Muniba Mahmood
The healthcare system in Pakistan has been fragmented and uncoordinated for as long as we can remember, and it cannot be emphasized enough that this sector needs intervention for a comprehensive health management system.
Currently, costs associated with healthcare continues to increase at a sky-rocketing rate and the condition, especially for the poor, is not only unstable but far from ideal.
Over the past few years, a number of policies were implemented to bring people under a health insurance umbrella. However, considering the lack of resources and proper implementation of guidelines, no such policy was fully successful. The Waseela-e-Sehat program and Prime Minister National Health Programme were two such government-initiated programs with a budget of Rs. 25 billion. Unfortunately, both programs were abandoned in 2016 due to economic constraints. The beneficiaries of these programs were also identified through NADRA’s database, but the verified number of the beneficiaries is not known due to the unavailability of any consolidated data.
As the saying goes, there is always a light at the end of the tunnel. A star performer is the government-led Sehat Sahulat Program (SSP) which bore fruit when it was launched as a pilot project in Khyber Pakhtunkhwa. The concept of state-sponsored health insurance is relatively new in Pakistan. The primary aim of this program is to extend access to affordable healthcare coverage to millions of previously uninsured and non-medicare eligible families. The idea is to provide access to quality health services and to reduce poverty through the reduction of out-of-pocket payments for health expenditures.
The SSP scheme rolled out in four phases and is now covering the entire population of KP (including merged areas covered by the federal government). Seeing the success of the program, the government has decided to roll out SSP for its entire population of Punjab in one go. It is an ambitious target, and the idea is to have a Rs. 100 billion health insurance scheme with coverage of Rs. 1 million for each family by the end of this year.
An industry expert stated:
Ensuring that all people in the country have affordable health care coverage that provides a defined set of essential health benefits is indeed necessary in order to move toward a healthier and more productive society. Additionally, our healthcare system must begin to account for and address social determinants that have a profound impact on individual and population health outcomes and costs, such as socioeconomic status, housing and occupational conditions, food security, and the environment.
Another industry expert commented:
A programme designed to provide health care coverage to all people will have a deep impact on its ability to make sustainable and systematic improvements in access to care, quality of care, efficiency, and cost control. However, implementation in one go in the biggest province of Pakistan is definitely a challenge, and if successful, will have historic impact on the country.
All is hale and hearty until it comes to implementation. In an ideal situation, the program will take on board public and private insurance companies and make a mix to roll out the plan. In Pakistan, there are 20 to 25 private insurance companies, whose support can make a huge difference in the implementation of this program. The repercussion of going for just one state-owned firm to implement the SSP for such a major province poses a threat to all other private companies. The reason being that a lot of individuals have already bought policies from these firms; if given another health policy, the price of which is already paid for, then no one will be willing to hold two policies from two different companies. This could be detrimental for the private sector which has an organic growth of around three decades.
This may discourage the private sector health insurance companies to expand and offer a better product range for the benefit of the public, as the program would create a monopolistic environment for the government organization. As a growing economy and insurance sector still on the road to thriving, it can be detrimental to all the private sector companies with a long-term negative impact on their growth.
As a definite reaction, the input costs will go up and the burden will automatically shift to the customer and make the insurance more and more out of reach of the general public. In an ideal world, the program should result in peace of mind for all, not just for the customers, but for the firms operating in both public and private sectors as well. Only through this way, a positive program with such a huge magnitude can win in all areas of socio-economic growth of the country.
