Social Insurance as Health Care System Financing in Pakistan: Is it a Solution to all Healthcare related Problems?

Abstract

Social health insurance based financing is one of the many mechanisms for collecting and pooling the funds to health services, along with tax-financing, private health insurance, community insurance, and out of pocket. It should not be considered the only solution for health system financing, and it is not always raising additional funding for health system.¹ A health system is the organization of persons, institutions, and resources that deliver health care services to fulfill the health needs of the populations.  A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes the efforts carried out for improving determinants of health.² A health system includes public sector facilities and private facilities, which deliver preventive, curative and personal health services. It also includes behaviour change programs, vector-control campaigns, health insurance system, inter-sectoral coordination and legislation. The goals for health system include providing good health for its citizens, being responsiveness to the expectations of the population it serves, and fair funding services. The achievements towards these is based on how a health system carries out following key functions; provision of health care services, resource generation, financing, and stewardship.¹

Financial resources may be generated by; general taxation from people, health insurance which include both public or private health insurance, out-of-pocket payments and charities. There is a mixed pattern of these financing models in most of the countries. The use of the data on health status of population and healthcare services provision, and expenditure lies at the root of evidence-based policy and evidence-based management in health care system functioning. The outcome of the health system functions is based on multiple interrelated factors including management type of health care delivery system, policies and plans adopted by government. It is also in the domain of policy makers and managers to decide how financial resources are to be collected and allocated for the individual sectors of healthcare system.

The Government in Pakistan has rightly planned to implement social insurance of the general population, and it is going provide insurance coverage to masses. It is decided to shed some of the financial burden of the healthcare provision and share it with the insurance companies. It is worth noting that whether paid out of pocket, or through government taxes or insurance companies, the real source of the health financing would be ultimately the community itself. Hence it would be too early to say it to be a real change because of its sustainability in long term. This idea of insurance based financing for health care delivery was borrowed from many developed countries, but in the process it ignored many key aspects while implementing this model in Pakistan, including feasibility and sustainability of this initiative. It would have been better to critically evaluate the key indicators of those developed countries where insurance based financing is already functioning for quite some time now. The developed countries do have very strong economies in first place, which we lack, and would be affecting the sustainability of this financing mechanism in our country. Additionally, as far as the efficiency is concerned, the cost and waiting times of some of the medical services provided, in many of the developed countries, having insurance based financing, should have been discussed before implementing it in Pakistan. Many developed countries having insurance based financing for healthcare are relatively not good in healthcare indicators like, life expectancy, infant mortality, cost and waiting times for the patients.³ This signifies that besides insurance based financing, there are some other factors which play key role in defining the outcome of healthcare delivery system, which includes economy of the country, and population growth rate.  So decision to implementing insurance based financing in our country must have been a well thought out decision.  The reason for it is that taking this health financing option as an only solution for all the healthcare service delivery problems, is far from the reality, as we have multiple reasons underlying this complex issue. The political fraternity usually goes for politically motivated short term solutions most of the times, ignoring the complexities of the issues. The reason behind this dilemma is that we as a nation are not having an attitude of evidence based practices. The evidence that shall guide for rationalistic identification of the problems in health care delivery system, scientific way of choosing interventions for solving these problems, and evaluating such system in a standardized way. Most of the efficient health systems in world are practicing evidence based strategies. They look for the problems in their healthcare delivery system and identify their own society based solutions, which are culturally, socially and nationally acceptable. In our country, although social insurance in the name of Sehat Sahulat Program, may lead to improvement in some aspects like catastrophic health expenditure, it should not be considered as a sole solution of every health services related problems, hence other factors  specifically, uncontrolled growth of population should not be ignored. Additionally, a focus on insurance based healthcare financing must not divert our attention from the core issue of exponential population growth in country,  and this make relevant policy to address this key issue at national level as well.

References:

1. Social health insurance. Health systems. World Health Organization. Available at: https://www.who.int/healthsystems/topics/financing/healthreport/26_10Q.pdf.
2. World Health Organization. (2000). World Health Report 2000 – Health systems: improving performance. Geneva, WHO. Available from; http://www.who.int/whr/2000/en/index.html
3. Health status. OECD. Available from; https://stats.oecd.org/index.aspx?queryid=24879