Daily Times

As SSP is in line with SDG 3.8b (financial risk protection), major threats to its sustainability merit serious consideration. At present, the whole of the premium is paid by the government. This amount would balloon with time, as with the increasing population and increased utilization of services, the gap between available resources and demand would grow. Also, the State Life Insurance Corporation, being the single available management body, can have capacity limitations, which could, in turn, compromise the quality due to lack of competition. Lack of awareness of the availability of SSP by a large number of poor non-utilizers is also a cause of worry, though NADRA is playing its role efficiently., The lowest tier of the poorest of the poor, as well as vulnerable and marginalized groups (PWDs, older people, informal labour, especially agricultural women labour, and migrant workers), should be enrolled more aggressively for SSP. The number of empanelled hospitals is not adequate, as there are 825 hospitals for more than 100 million population of Punjab. According to WHO recommendations, the minimum hospital beds to population ratio should be 3/1000. According to World Bank 2017 statistics, the current ratio in Pakistan is 0.63 /1000, which is highly inadequate. In KP, it is observed that private hospital bed occupancy is 70 per cent although more beds are available at public sector hospitals. In such a situation, the quality of care in these hospitals should be high and uniform. The empanelled hospitals pass through specified selection criteria, but there is a need to make the assessment criteria more objective and effective in implementation. SSP is also facing some issues on the demand side as well e.g double dipping or duplication of insured treatment (reimbursements for the public sector, private sector, INGOs) has been observed, which is a burden on the resources of the government. There is a need to devise a more efficient mechanism of monitoring to stop the duplication of resource utilization.

Focused conversations on SSP are also timely as the country heads into elections so that different political parties compete with each other to provide better healthcare to Pakistani citizens.

For the sustainability of this program, we can learn from the countries like Chile and Taiwan. They have combined social health insurance with contributory health insurance and have introduced robust monitoring, ensuring the provision of health services to their citizens with equity. In Chile, the beneficiaries were divided into tiers according to economic status and the two lower tiers, which included pensioners as well, were provided with all health products free of cost and the other two tiers were provided with basics and were supposed to contribute for the treatment they wanted either from the public hospitals or from the private facilities.

In Pakistan, 2021 and 2022 were very crucial when universal health insurance was introduced in KP, ICT, GB, AJK, and Punjab. This is the right time to look back and evaluate the program from policy to service delivery and demand and supply side for its sustainability and meeting its original objectives. This will provide the necessary foundation to undertake evidence-based planning for the future. Focused conversations on SSP are also timely as the country heads into elections so that different political parties compete with each other to provide better healthcare to Pakistani citizens. The political parties would be well advised to initiate internal discussions on the following key questions/choices, to develop and present a clear and comprehensive framework to the electorate:

Would the strengthening of public sector health facilities and human resources improve the utilization of public health facilities and will be cost-effective?

How to reduce the sustainability and equity risks of SSP?

How to involve the Health Care Commissions and Health Regulatory Authorities more effectively in the empanelment of hospitals and monitoring of the quality of care at a health facility?

Would the registration of hospitals improve the quality of care and help government better plan the sharing of responsibilities between the public and private sectors?

How to strengthen the uniformity in management protocols and treatment guidelines to standardize the quality of care and facilitate effective monitoring?

Critically review the role of the private sector and public-private partnerships in health service delivery to enhance the synergize between the public and private provision.

Quality conversations within the political parties on addressing the social health protection challenges would go a long way in making our healthcare system citizen-centric, strengthening the social compact between the state and the citizens.

The writer is the Advisor for the Centre for Health Policy & Innovation (CHPI) at Sustainable Development Policy Institute, Islamabad.