National Health Insurance Scheme in pipeline

If the available statistics are anything to go by, then only a quarter of Pakistan’s population is covered for health care costs with the rest, mostly poor people in cities as well as villagers, paying out of their own pocket for healthcare.

With more than 25 per cent of the population living below the poverty line, many are pushed into the ‘medical poverty trap’, or worst, do not receive any care. Catastrophic health expenses are more likely to incur in rural areas and increase due to the growing number of women in every household and members aged over 60.

Considering these circumstances necessitates financial risk protection for healthcare, the Ministry of National Health Services, Regulations and Coordination intends to initiate the ‘National Health Insurance Scheme’ to provide the people with comprehensive health cover.

According to the relevant officials at the ministry, the scheme, which is in the phase of conceptualisation, will be run jointly by the federal and provincial governments.

The proposed strategies for it include free coverage for essential services through government health systems (outreach and primary health care services) and broadening the base of pooling by augmenting health insurance schemes at provincial and federal levels.

Broad heads of such coverage include preventive care to be provided free of cost through outreach programmes, primary healthcare free of cost through primary healthcare facilities, secondary health care through insurance to be funded by provinces, and tertiary and sp diseases through insurance funded by the federal government.

The officials insist recognising the fact that capacities and resources at federal and provincial level should be pooled to cover the whole population with an effective financial risk protection system, a collaborative model between federation and provinces is being envisaged.

“First the initial focus will be on population below the poverty line but a clear vision towards universality of coverage will be crystallised, and second the kind of services, which are feasible to offer based on prevalence, practicality, impact on poverty and availability, will be key consideration for developing such a system,” said an official.

Under the plan, the provincial governments will contribute premium covering common ailments and injuries with financial implications up to Rs35,000, whereas the federal government will contribute premium covering serious ailments like cancer, heart diseases, all forms of hepatitis and specialised surgical procedures.

To serve this end, a fund will be established and the scheme will be operationalised either through an existing insurance company or register a new company with the Security and Exchange Commission of Pakistan under the Companies Ordinance, 1984.

The nearest tertiary care hospitals of their respective areas will be on the panel for patients and only secondary hospitals will refer patients.

The patients will only be allowed to go to the hospitals in own districts (integrated with the National Database and Registration Authority), while there will be Rs2 million in-hospital complementary cover for victims of terrorist activities.

The scheme will be implemented in three phases.

The first phase will cover 15 districts in the country with their selection being made in light of availability of facilities and security situation.

The number of districts will be increased in the second and third phases.

The ministry believes besides improving healthcare, the proposed scheme will also revitalise the public as well as private health facilities in the country by creating demand in the communities for essential services in a regulated environment and by generating a healthy competition on supply side.

“We will oversee and monitor the national insurance fund/trust. Besides, we will also facilitate the initiative by creating a dedicated unit at the ministry to ensure efficient progress as per the developed action plan, providing a platform for advocacy, technical and operational deliberations, and monitoring performance,” an official said.

When contacted, State Minister for National Health Services, Regulations and Coordination Saira Afzal Tarar confirmed that a health insurance scheme was on the anvil.

She, however, said the ministry had sought the advice of the law ministry first on whether any legislation is required to initiate the scheme and second on if legislation is required, whether the federal government can table a health insurance bill in parliament in the current post-devolution regime.