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Revamping healthcare

December 06, 2018


IT is laudable that our government is alive to woefully inadequate medical facilities for the common man. No healthcare system, not even the US ‘system’, in the world is perfect. Yet, each, by and large, delivers the goods. What about ours?

The familiar medical system of wealthy countries is the Bismarck model (multi-payer health-insurance model), the Beveridge model, the National Health Insurance Model, the out-of-pocket model, and the US model. The government should pick up good points of medical systems of wealthy and poor countries alike. The Bismarck model is being followed in Belgium, France, Germany, Japan and Switzerland.

Generally, healthcare providers in this model are private entities. The government neither owns nor employs most physicians. Health insurance also is provided by private companies, not by the governments. Governments strictly regulate costs and other aspects of healthcare (no arbitrary fees and fleecing). The US outspends its peer nations on health. Yet it has no universal-health insurance, nor universal health coverage.

Thailand’s successful healthcare plan reflects three lessons: being prepared, exercising tight control, and being pragmatic and politically broadminded.

Thailand took opposition and other stakeholders aboard. As such, the plan remained intact despite change of governments. Thailand’s per capita income, health expenditures, and tax base is comparable to India. Yet, it achieved universal healthcare in 2002.

It spends around four per cent of its Gross Domestic Product on health. In Thailand out-of-pocket medical expense has fallen to 12 per cent, as compared to 40pc to 60pc per cent in wealthy countries. The proportion of children dying in the first five years of life fell to less than 1.2pc. Thailand saved money by shutting down or consolidating selected good-for-nothing lackadaisical hospitals (like ours) that had large government budgets.

Short of funds, we should put our fragmented unbridled hospitals under one civil-military supervisory board, and distribute load reasonably. The facilities at PIMS should be improved, including increasing number of ventilators.

The politically-expedient burden of residents of Rawalpindi/Islamabad on Federal Government Services Hospital should be taken off. The hospital is now good.

The ‘civilian officers paid out of defence services’ should be empanelled to military (CMH/AFIC) and other hospitals (like Shifa International or Aga Khan’s) for secondary and tertiary treatment to reduce FGSH patient load.

For one-thing our healthcare system, like our education and law-and-order systems, is on auto-pilot mode.

Maryum Malik


Published in Dawn, December 6th, 2018