PESHAWAR: Private hospitals are likely to lose bulk of revenue generated through Sehat Card Plus (SCP) after the decision of Khyber Pakhtunkhwa cabinet to restrict seven common surgeries and procedures under the free health initiative to public sector hospitals.

“From today (October 1) onwards, there will be no caesarean delivery, tonsillectomy, cholecystectomy, appendectomy, cataract, angiography and septoplasty and submucosal resection (SMR) on SCP at private hospitals,” officials said.

They said that those operations and procedures would be conducted only in government hospitals on Sehat Card Plus. “Currently, 192 hospitals are admitting patients on Sehat Card Plus including 129 private and 63 public hospitals,” they added.

The caretaker provincial government has been making efforts to cut down budget of SCP. The government has already decided to provide free treatment services to 65 per cent population of the province and the make the rest of 35 per cent to share the cost of their healthcare under the copayment system to be started from November 1.

Officials say govt wants to improve financial position of public sector health facilities

So far, the programme covers the entire population of Khyber Pakhtunkhwa. Officials said that in order to slash down the cost of the programme, the decision to limit commonly-conducted surgeries will deprive private hospitals of the income they got through SCP.

“The private hospitals have been getting most of their income from SCP through these common surgeries but now they would not be permitted to admit patients for these health issues under the programme,” they said.

They said that some of the private hospitals subjected people to those common surgeries out-of-need to claim money from SCP but now those cases would be conducted only in public sector hospitals.

“It will cut down the flow of patients to private hospitals by more than half in the Peshawar-based private health facilities and more than 90 per cent in district level private hospitals,” said officials. They said that treatment of other than those seven surgeries was available in very few private hospitals and that too in Peshawar.

“On the other hand, it will improve the earnings of public sector hospitals from the scheme. The government wants to enable public sector hospitals to improve their earnings from SCP,” they said.

Officials said that the government had also decided to cut down the regular budget of the medical teaching institutions (MTIs) because they were already making money from SCP. Assigning those surgeries to MTIs would strengthen their financial positions, they added.

They said that the new decision would also give financial benefits to public sector district headquarters hospitals that had been lagging behind private health facilities in many districts as far as income from the health insurance scheme was concerned.

“All the DHQs have the facilities and professional staffers to carry out these general operations and procedures. Therefore, the government wants to encourage them,” said officials.

They said that government was also starting reassessment of the infrastructure of the already empanelled private health facilities. They said many private hospitals would lose their entitlement because the eligibility criterion was tightened and only those having standard services would remain empanelled.

Officials said that the 65 per cent poor people in the province would still get free services under SCP at standard hospitals. The new mechanism would not only save money but would also benefit the patients, who would not fall into wrong hands, they added.

Since launch of the programme, the government has cancelled empanelment of many hospitals for indulging in mistreatment of patients and selected new health facilities to cater to the growing demand of the patients. “Selection of new hospitals and cancellation of older ones for bad performance is a usual exercise to ensure better services to people,” said officials.

Published in Dawn, October 2nd, 2023