PESHAWAR: With 63 per cent of the Sehat Card Plus beneficiaries receiving treatment in private hospitals, the government should provide funds to its health insurance programme without hindrance and make it more effective and transparent by strengthening the directorate of the social health protection initiative, say the Aga Khan University Karachi and German development agency GIZ in a survey report.

According to the survey findings, which were released on Monday, 65 per cent of patients benefitting from the SCP programme went to the secondary care hospitals at the district level and 35 per cent to the tertiary care outlets in cities of the province, and the rest to health centres in other provinces.

It said that 84 per cent of the population proposed the inclusion of outdoor medication in the SCP, which catered to in-patients only.

The survey said that 10pc of the residents had yet to benefit due to a lack of the local domiciles or citizenship, while 84 per cent proposed that outdoor treatment be included in SCP on which only admitted patients were entitled to the cashless medication.

Govt urged to ensure smooth funding for health insurance programme

It added that the average cost per patient was Rs31,395 and 2.2 million people had undergone free treatment under the programme since 2016.The survey found that the people wanted to include local citizens in the policy board so that the issues could be highlighted in a better way.

It added that the level of awareness of the SCP was 90pc and six diseases accounted for 71pc of all hospital admissions, including pregnancy, childbirth and puerperium (15.3pc), digestive system diseases (14.4pc), circulatory system diseases (13pc), respiratory system diseases (10pc), contact with health services (9.6pc), and eye and adnexa diseases (8.8pc).

The survey said the average length of patient stay under the SCP was 2-3 days.

It found that the SCP programme’s policy board had representation from both public and private sectors but lacked stakeholders representing the citizens and providers.

“The directorate of social health protection initiative (SHPI), which has a pivotal role in managing the programme, is bereft of technical staff and lacks IT capacity and infrastructural support. It needs to be strengthened to ensure independent monitoring of the programme.”

The survey recommended authorities to ensure financial sustainability of the programme by allocating adequate funds to meet the demand of rapid expansion of population coverage from targeting poor to fully subsidised entitlement for all in addition to engaging the Health Care Commission, Health Foundation, and Independent Monitoring for effective and enhanced implementation of the intuitive.”In the long run, the government needs to consider establishing an autonomous purchasing agency or health insurance organisation to administer the programme and reconsider the current reimbursement as a top-up pay to public hospitals by reducing direct budgetary allocation and maximising the effect of strategic purchasing by programme on hospital performance.”

According to it, measures should be put in place on an urgent basis to build capacity in remote districts by upgrading secondary hospitals in the public, while private sectors and case-based payment methods should be adopted.

Regarding challenges and opportunities for improved programmatic governance, the survey said that gaps and opportunities for improved service delivery including, access of program to all the beneficiaries, quality of care, monitoring and surveillance, utilisation of insurance-related MIS, appropriateness of beneficiary enrolment, benefits package, premium setting, empanelment of health facilities, and claims reimbursement should be considered at the earliest. It added that the level of user satisfaction and equitable utilization by the insured population should be ensured to further improve and sustain the programme.

Adviser on health Prof Riaz Anwar Khan promised the provision of funds to the SCP programme.

He asked the programme’s implementer,State Life Insurance Corporation, to desist from sending letters for payment to the government saying the act “amounts to the breach of trust.”

SCP CEO Dr Riaz Tanoli also spoke on the occasion.

Published in Dawn, June 6th, 2023