EDITORIAL: The Khan administration’s salutary focus on expanding the Sehat Sahulat Programme (SSP) is not only a reflection of the Prime Minister’s overarching focus on introducing and then expanding social security initiatives to include ever larger numbers but also a rising need given the growing poverty levels in recent years. The premise of this programme is to provide health insurance up to a maximum of 700,000 rupees – a limit that may be raised by 300,000 rupees in the event that the funds ran out during treatment. Data on the SSP website indicates that as of 26 May 2021 total families enrolled were 7,776,966 while hospital visits were 1,751,102.
While Imran Khan has without doubt expanded SSP considerably yet providing free medical aid to the poor and vulnerable through a micro health insurance scheme under the umbrella of the Benazir Income Support Programme (BISP) began during the tenure of the Zardari-led government titled Waseela-i-Sehat programme. Nawaz Sharif launched Prime Minister’s National Health Insurance Programme on 7 February 2015 with the then Chief Minister Punjab Shehbaz Sharif establishing Punjab Health Initiative Management Company (with the incumbent Punjab government continuing to use this as a platform) to provide access to good quality medical services with a paltry 1.5 billion rupee budgeted allocation. A Punjab government official recently revealed that the province is expected to set aside 70 billion rupees for healthcare facilities.
The programme launched by Nawaz Sharif was not supported by the Imran Khan-led Khyber Pakhtunkhwa government (2013-18) and in September 2016, the KPK government launched the Sehat Insaaf Card to be issued to 1.8 million households entitled to free medical treatment up to 540,000 rupees per annum. Prime Minister Khan tweeted on 1 February 2021: “congratulations to KP government for making KP first province in Pakistan with Universal Health Coverage for all KP domiciled citizens covered with free health insurance. Free treatment up to Rs 1 million per family per year in over 400 government/private hospitals across Pakistan.” This is a remarkable achievement; however, there is one outstanding concern that needs to be reviewed – frequent monitoring of incidence rates and every two years a full actuarial and statistical experience analysis as well as premium adequacy review.
The last full actuarial review was held in April 2019 commissioned by the German GIZ (which provided technical support to the Waseela-i-Sehat programme) and was undertaken jointly with International Labour Organisation’s Impact Insurance (a facility that enables insurance companies, governments and partners, to embrace impact insurance to reduce households vulnerabilities, promote stronger enterprises and facilitate better public policies). The study’s findings are as follows: (i) admission rates were low in comparison to other countries as well as baseline survey in Pakistan which projected a major increase in future; (ii) projected claims costs and expenses (nominal terms) are very sensitive to the assumed increase in utilization, assumed increase in unit cost and fairly sensitive to the family size assumption. In this context, it is relevant to note that inflation in April 2019 was less than 7 percent, rose to around 12 percent in 2019-20 and is projected to be higher than 8 percent in the current year. Drug prices have sky-rocketed as have all other associated costs including the price of electricity; (iii) projected demographic changes – if they are small then there would be minimal impact on cost of claims and premiums; and (iv) the baseline indicative premium required from the projection model is 1,755 rupees per family per annum — an amount that without doubt would need to be upgraded.
It is important to note that the card numbers and the hospital visit rates are rising very fast and one would hope that the actuarial review has already been commissioned, and if not, will be commissioned soon and ideally its results would support the exponential rise in the number of cards being issued. If such support is not there then the government may have to slow down the disbursement of these cards to ensure the sustainability of this extremely good programme.
Copyright Business Recorder, 2021