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PTI’s Flagship Sehat Card Faces Uncertain Future

Empaneled private hospitals blame delayed payments, unsustainable pricing mechanism for decision to withdraw from program

by Sumeera Riaz

P.M. Khan  inaugurates health card facility for all residents of Lahore division on Dec. 31, 2021. Photo courtesy PID

Complaining of delayed payments for medical treatments, as well as uncertainty over the new government’s commitment to the initiative, private hospitals across Pakistan have quietly stopped treating patients availing the former regime’s flagship Sehat Insaf Card, even as authorities insist all empaneled hospitals must continue to accept the health insurance scheme.

The Pakistan Tehreek-e-Insaf (PTI)-led government launched the Sehat Insaf Card in Khyber-Pakhtunkhwa in 2020, allowing every family in the province to avail medical treatment worth up to Rs. 1 million free-of-cost. Hailing its success among the public, authorities subsequently extended it to Punjab and Islamabad and announced it would also be available to residents of Gilgit-Baltistan, Pakistan-administered Kashmir, and Balochistan—areas under the PTI’s control. Prior to its ouster, the government had said it would soon extend it to Sindh as well, even though the provincial government led by the Pakistan Peoples Party has repeatedly voiced concern over its sustainability.

According to official statistics available with Newsweek, from Jan. 1, 2022 till April 8, 2022, 419,181 patients availed health cards for admission to various hospitals across Punjab against claims of Rs. 8,497,838,788. Of these, 121,017 admissions were in public hospitals with claims of Rs. 2,285,831,676, while 298,084 admissions were to private hospitals against claims of Rs. 6,212,007,112.

The government had described the health card as a milestone for social welfare reforms, with then-prime minister Imran Khan repeatedly stressing that it would benefit under-privileged citizens nationwide, as well as boost the availability of quality healthcare providers in remote regions. However, in the weeks leading up to the vote of no-confidence that concluded with Khan’s ouster and the en masse resignation of PTI lawmakers from the National Assembly, several private hospitals stopped entertaining patients availing the health insurance scheme, setting off alarm bells on social media.

“Yes, these reports are true that the private sector is no longer treating patients on health cards and many hospitals are considering terminating their affiliations,” confirmed Pakistan Medical Association (PMA) Secretary General Dr. Qaisar Sajjad. “We are getting reports from big cities of Punjab like Lahore, Faisalabad and Rawalpindi that private hospitals have stopped entertaining health cards and thousands of patients are being diverted towards public hospitals,” he added.

Lamenting that the laudable program had been mismanaged, he identified the government’s pricing mechanism, delayed payments and refusal to accept the input of the private sector as major problems in its functioning. “Some of the private hospitals have raised the issue of delayed payments which was forcing them to stop treating patients,” he confirmed, saying that the fate of the program was also hanging in the balance due to massive postings and transfers due to regime change.

Payment woes

Ghurki Trust Teaching Hospital, best known for its Department of Orthopedic and Spine surgeries, told Newsweek it had terminated its operations under the Health Card Program. “We have terminated our alliance with the program because of the low treatment rates being offered by the government for surgeries, as the hospital is unable to bear the cost of medicines, surgical tools and operation theater protocols and infection controls,” said Medical Superintendent Dr. Khurram. “Rates being offered by the government are not even enough for the medicines used for surgeries let alone other services,” he explained, adding: “For instance, spine surgeries require implants, spacers, plates, clamps and hooks. The package given by the government is Rs. 80,000 for the procedure while the implant alone costs the hospital Rs. 120,000.”

Giving another example, he pointed to the Rs. 22,000 rate being paid by the government for Caesarean deliveries in private hospitals. “Only the medicines used during this operation cost Rs. 18,000, let alone the other services,” he claimed, adding that these problems had been conveyed to the Punjab Health Management Institution but they had failed to overcome them.

Orthopedic Surgeon Dr. Naeem Ahmed, who practices at the Punjab Medical Center, told Newsweek that all private hospitals located along Lahore’s main artery, Jail Road, had started to refuse admissions against the health cards. “Uncertainty over the continuity of the program by the current political set up and the previous government’s inability to revise the packages for the treatment of surgeries in private hospitals are the main obstacles to the private sector entertaining new patients,” he said.

“Now, private hospitals are either refusing patients on health cards or are manipulating procedural matters to such an extent that patients are going away without any treatment,” he alleged, adding that it was regrettable such an “excellent” program had faltered because it was devised by non-technical people who could not plan it on the basis of ground realities.

Some hospitals, according to staff, have even started to adopt a “pick and choose” policy with the types of treatments they offer under the health cards to avoid heavy losses under the pricing mechanism. This results in patients needing high-cost procedures being turned away from hospitals in favor of patients requiring low-cost treatments.

Another problem, noted the PMA, was the manner in which ‘hospitals’ had been empaneled in remote regions. “In far-flung areas, only periphery hospitals—where the owners are themselves surgeons—are making profits or treating patients on health cards … as they can easily escape the checks and balances regarding the use of substandard medicines and low-quality equipment,” claimed Dr. Sajjad. “Our government hospitals are in a pathetic shape. Instead of pumping money into private hospitals for the medical services, the government should have upgraded those public hospitals,” he added, reiterating a common refrain from critics of the Sehat Insaf Card initiative.

While Punjab, by virtue of its population, has reported the highest number of private facilities refusing to accept health cards, multiple reports have noted that there is a similar practice under way in Khyber-Pakhtunkhawa, where the PTI remains in power.

Government denial

Denying all reports of the government stepping back from the health card program, Punjab Health Secretary Javed Ahmed Qazi told Newsweek that all empaneled hospitals must continue to offer treatments as no orders had been issued to the contrary. Claiming that payments had not been delayed, he said all outstanding dues were being cleared by the State Life Insurance Corporation within four weeks, as was stipulated in contracts with healthcare providers.

Stressing that “strict action” would be taken against any empaneled private hospitals that were not entertaining patients on the health cards, he said: “Let us [authorities] know if any hospital stops treatment on the health card and we will take action.”

The government’s reassurances, however, ring hollow for citizens who have already been turned away by hospitals they had been assured would cater to them. Adnan Malik, a resident of Islamabad, told Newsweek doctors had refused to treat his 3-year-old son on the health card when he had required urgent surgery. “The surgeon asked me to bring Rs. 50,000 for the surgery, as they were no longer entertaining patients against the health card,” he alleged.

The PMA’s Dr. Sajjad, meanwhile, maintains that all is not lost and there is still time to ensure the program’s deficiencies are addressed and free healthcare continues for the impoverished. “There is enough room to redefine the potential of this initiative and bridge the gap between the rates of services being provided to patients in public and private hospitals,” he advised.

With a new government led by the Pakistan Muslim League (Nawaz) now in power, it remains to be seen if the political will to improve the health insurance scheme will overcome Pakistan’s long-held tradition of subsequent regimes abandoning their predecessors’ initiatives in favor of their own policies.

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