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
Comments are closed.