Taimur Khan Jhagra talks about the monumental Sehat Card Program and Khyber Pakhtunkhwa’s road towards universal health coverage. He talks in depth about the big and bold steps the KP government is taking towards ensuring each and every KP domiciled person will be protected against health crises that are the biggest factor behind financial disaster that the poor face.
The Sehat Card Programme started in 2015; how many families is it covering today? Is Khyber Pakhtunkhwa fully covered now?
The current programme is covering just over one-third of the families in Khyber Pakhtunkhwa today, plus all the population of the former tribal districts. The new programme, which will now be called Khyber Pakhtunkhwa’s Sehat Card Plus programme, is bigger in terms of coverage and ambition, with the total package increasing from Rs. 600,000 per family, to Rs. 1,000,000 per family. On October 31, every resident across six districts (Upper and Lower Chitral, Upper and Lower Dir, Swat and Malakand) will get coverage. That is 7 million people who will get coverage on a single day. Insha’Allah, by January 31, in 4 phases, if all goes well; every resident of the province will get the same coverage. That is almost 40 million people. This is an achievement we feel exceptionally proud of.
This concept of giving universal coverage, to everyone, is what stands out. Can we afford this? And wouldn’t this mean that people like me are also covered? How do you justify that?
Look! It is the big and bold ideas that will change Pakistan, not just incremental progress. Healthcare is both a universal right, which is why covering everyone is a good idea; and the right investments in healthcare will increase the quality of life and economic activity. It will also reduce the costs of combatting disease, at a social and administrative level.
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The story of how the idea of universal health coverage came up is an interesting one. We had a review of the programme with the Chief Minister and were discussing increasing coverage from one third to two-thirds of the population. We very quickly realized that instead of the cost of continuously paying for BISP surveys that cost billions, we should invest that money in giving coverage to everyone. This would make the programme simple, fully transparent, and demonstrate our government’s commitment to providing quality healthcare to everyone.
Why was this programme needed – people can go to a government hospital for free treatment already? What has changed?
A lot. But the simple answer is choice and competition. By providing health insurance, you allow the citizen to choose where he wants to get treatment, which is why we have asked State Life, our service providers, to empanel as many hospitals as possible, not just in Pakhtunkhwa but across the country. They have already empanelled over 200. Because these include both public and private hospitals, and because some of the money flows to hospitals and the doctors themselves, this should create competition in the health sector that lifts standards across the sector, to the benefit of the common citizen.
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More so, remember that even within public sector hospitals, not every service was free. Even nominal payments can be a burden for the working class; the Sehat Card and now the enhanced Sehat Card Plus programme change that, providing coverage for all inpatient services including doctor fee, investigations, admissions, surgery and medicine; within the programme limits.
Will outpatient services be similarly covered?
Maybe in the future, we could introduce a top-up programme where outpatient coverage could be an option. At the moment, doing so would make the costs of the programme prohibitive; we are already budgeting close to Rs. 20 billion a year for the enhanced programme.
It has been said government hospitals will improve their service after the introduction of this programme – why do you say that – will doctors or administrators get fired?
No. No one will get fired because of the Sehat Card Plus programme. But we believe that more than what you said will happen. Not only will government hospitals improve, but we hope and believe that the private sector will also expand and improve in Khyber Pakhtunkhwa. Traditionally, in Pakistan, you’ve had good hospitals in big cities. But because everyone will have health coverage, from Chitral to Dera Ismail Khan, I would expect the private sector to see the opportunity here, and quality private-sector health establishments to spring up across Pakhtunkhwa. It is this competition, where hospitals and hospital leadership are incentivized to benefit from this programme that will lift the quality of services on offer, across the public and private sector.
Of course, government hospitals will also improve their service because we have a very ambitious programme of investment, reform and innovation in the public health sector other than the Sehat Card that we can talk some other time about.
State Life runs the program – how are they charging you?
State Life won a competitive procurement process which saw a lot of interest. The programme is based on a flat per family charge of Rs. 2849 / family/year; with excess profit to be returned to government and downside risk capped. It is a well thought out structure in what is a very ambitious programme.
What about the utilization rate?
Current utilization is at 3.8%. This will go up gradually; we can’t say exactly, but the programme is designed to safely allow this double.
What sort of costs are incurred by patients on treatments covered by the Sehat Card?
When you talk major tertiary care interventions (cardiology, cancers, neurological, ICU care), the cost of coverage easily goes into lakhs of rupees. The coverage provided by the Sehat Card for a heart bypass surgery for a poor patient, for example, saves the life of a person, as well as saving them from being crippled financially. Many secondary care procedures, take an appendix operation, could cost between Rs. 50,000 to Rs. 100,000. This, along with other abdominal surgeries, gynae, typhoid, minor accidents and fractures, respiratory tract infections requiring hospitalization, these are all covered.
Are hospitals outside the province covered?
Every permanent resident of Pakhtunkhwa will be covered, whether they live in the province or outside. And yes, hospitals outside the province will also be covered. We will push to expand coverage continuously, and I’ll tell you why. The primary aim is to provide a benefit to the citizens of this province. So why should I care if someone ends needing to get treatment in Islamabad rather than Peshawar?
Where do you go in the future with this?
Great question. Once you have enrolled an entire population in a programme, there are many advantages. We want to see the programme rollout, and then we can consider a large number of interventions. Top up coverage for liver and kidney transplants, for example, for poorer patients. Optional additional insurance for a small premium for government servants who already benefit from the same basic package. Other top-up services, such as blood transfusion. It’s a fascinating prospect, which is why our first focus is to get this ambitious phase of implementation right and ensure that this becomes an unqualified success.