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EDITORIAL: The Sehat Card, former prime minister Imran Khan’s flagship scheme, envisaging universal health for the province’s entire population implemented in the provinces of Punjab and Khyber Pakhtunkhwa where his party Pakistan Tehreek-e-Insaf (PTI) was in power that needs 400 billion rupees in annual subsidy, has been blocked by the federal government.

It is pertinent to point out that while this would not be generally well received, and maybe used for political point scoring by the PTI, is based on reasons that are part of the IMF programme negotiated and signed by the PTI government that envisages ‘targeted subsidies’ only like the Ehsaas Programme. However, for sake of clarity two observations are in order:

First, Imran Khan undoubtedly expanded the Sehat Card scheme both in terms of raising the target number of beneficiaries by making it universal and the amount of available funds, in a tweet on 1 February 2021 he claimed “free treatment up to Rs 1 million per family per year in over 400 government/private hospitals across Pakistan;” yet the scheme to provide free medical aid to the poor and vulnerable was first launched through a micro health insurance scheme under the umbrella of the Benazir Income Support Programme (BISP) (subsumed by Ehsaas Programme) initiated during the tenure of the Zardari-led government titled Waseela-e-Sehat programme.

In 2015, Nawaz Sharif launched Prime Minister’s National Health Insurance Programme with the then Chief Minister Punjab Shehbaz Sharif establishing Punjab Health Initiative Management Company (with the PTI-led Punjab government continuing to use this platform) to provide access to good quality medical services.

Second, in April 2019 an actuarial study commissioned by the German GIZ and jointly undertaken with the International Labour Organisation pointed out that admission rates were low at the time but projected that as more people became aware of this facility, admission rates would rise dramatically.

And, with claims costs and expenses (nominal terms) being very sensitive to the assumed increase in utilisation, assumed increase in unit cost and fairly sensitive to the family size assumption (with inflation in 2019 averaging at 7 percent but which today is over 24 percent leading to skyrocketing price of treatment and medicines) baseline premium would rise significantly from 1755 rupees per annum. The suggestion was to undertake an actuarial study every two years – a suggestion that was disturbingly never implemented.

Imran Khan’s Sehat Card was understandably extremely well received by the general public; however, it required massive amount of financial support from the federal government and the provinces which partly contributed to the unsustainable budget deficits for the past three years, and require resources today that are simply unavailable especially after the devastating 2022 summer floods that affected 33 million Pakistanis.

In this context, the donors are reportedly insisting that the universality of the Sehat Card be abandoned forthwith and instead a subsidy for health insurance be targeted to the poor and vulnerable through BISP — a programme that has been praised by international donors repeatedly as being targeted to the poor with Dr Sania Nishtar, Special Assistant to the Prime Minister on Social Welfare and Poverty Alleviation revising the BISP beneficiary list in late 2019 early 2020 to weed out the ineligible.

The premise of the donors has much merit from an economic point of view: extend targeted subsidies to the poor and the vulnerable through BISP which has already streamlined the beneficiary database by excluding the undeserving.

In other words, electricity subsidies, on staple food items (cooking oil, tea, sugar, etc.), health and education must be only through BISP. Any other mechanism fuels inefficiency, nepotism or corruption or an amalgam of all three.

Given the current economic impasse, it is hoped that decisions henceforth will be taken on economic grounds rather than for considerations of political mileage and while it appears, that as expected, this universal scheme did not pass muster in the ongoing negotiations with the International Monetary Fund on the ninth review and many such decisions would be reversed, given the Fund’s lack of flexibility and the government’s lack of leverage and that this time would stay the course to undertake the agreed reforms that are an imperative for the restoration of the economic health of the country.

Copyright Business Recorder, 2023

Comments

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Muhammad Arsalan Jamil Feb 15, 2023 08:47am
Your argument will not sail keeping in view the very fact that PM has appointed the largest cabinet, army of SAPMs, more than required bureaucracy and army. Why only masses suffer and no cut is made to expenditure of cabinet, ministers, bureaucracy and army.
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Amir Feb 15, 2023 10:48pm
What planet are you on? If state cannot provide basic health services to masses...who will? Ineed it will cost big money...why does the stste collect taxes..to serve masses...not let crooks loor and plunder...a very biased narrative!
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Syed Arsalan Ali Feb 16, 2023 11:30am
What a terrible way to justify the closure of Health Card? First, you try to take credit away from PTI by mentioning the almost non-existent measures of PPP and PML-N. Secondly, instead of pressing on reforming the taxation framework, you have justified the cutting of an investment initiative in human capital development.
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Nawaz Feb 16, 2023 11:49am
@Amir, govt. should provide free health to poors not to everyone
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M Saleh Feb 16, 2023 11:53am
Dear author, BISP is failed project that is given to few selected jiyalas. Meanwhile Sehat Card is the best thing happened to the country. Literally, first time in history, the government counted their citizens as human!
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M Saleh Feb 16, 2023 11:54am
@Muhammad Arsalan Jamil, couldn't agree more
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bilal hassan Feb 16, 2023 01:13pm
THE Govt Should decrease the luxury facilities in govt set ups such as expensive conveince facility ,foods and branded goods. Why govt provide 1000 CC + CARS to employees.The facilities of high grade officer and personals are also a big thing to decrease the economy .
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Dr tariq Mahmood Feb 16, 2023 02:33pm
But sahat card is still working in whole punjab
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Mian Feb 17, 2023 10:20am
@Nawaz, Any one who pays taxes must be eligible for health coverage like EU countries!
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