LAHORE: The Universal Health Insurance (UHI) Programme has almost collapsed at the primary and secondary healthcare hospitals as an official report unveiled that 86,217 patients out of total 104,846 were denied treatment under the progamme at all district headquarters hospitals (DHQs) of Punjab in just 25 days.

These patients had visited the DHQ hospitals from July 1 to July 25 and the official assessment report, prepared by the health experts, estimated annual loss to the hospitals to be more than Rs3bn (Rs3,136,636,000) as per the 34pc of the total claims of the health facilities. The remaining 66pc revenue was to go to the Punjab government, which also faced a loss due to the alleged collapse of the programme.

Keeping the loss of Rs645m within 25 days in mind, the experts estimated the approximate annual loss of Rs3bn on the basis of the total number of patients reported to all the DHQ hospitals during abovementioned period (July1 to July25). The experts declared in the report the 86,217 patients as ‘missed patients’.

The assessment exposed the ‘blatant negligence’ of the higher health authorities, stating that only 18,629 patients out of the total 104,846 (patients) visited all the DHQ hospitals of Punjab were given treatment under the UHI (Sehat Sahulat Card) programme.

Reports say 86,217 patients refused treatment in 25 days; annual loss to hospitals is Rs3bn; govt facing Rs9bn revenue loss

The report was shared in a conference of the chief executive officers (CEOs) of district health authorities of Punjab last month.

An official claimed that the report caused embarrassment for the Primary and Secondary Healthcare Department Secretary Ali Jan when the experts told him about the failure of the Universal Health Insurance Programme at the DHQ hospitals and the huge financial loss to the hospitals as well as the government exchequer. He said that some participants advised Mr Jan to shift his focus to the primary and secondary healthcare facilities, saying that the treatment standards of a majority of the DHQ and THQ hospitals had also drastically declined since he was holding charge of two health departments.

As Mr Jan is occupying the charge of specialised healthcare & medical education and primary and secondary healthcare departments at the same time, the experts requested him to quit one of the two top slots to give proper attention to the state-run hospitals in the best interest of the patients and healthcare infrastructure.

The official said that the experts shared further disturbing information in the meeting, saying out of the 86215 ‘missed patients’, 4,132 were the pregnant women who had visited the DHQs for delivery, 3,672 for C Section, 3,854 patients for different surgeries, 64,833 for indoor treatment, 2,501 visited the intensive care units/cardiac care units while 7,225 renal failure patients had visited for dialysis.

These patients were supposed to undergo treatment under the Universal Health Insurance programme. However, the experts confirmed to the health secretary that these patients were denied treatment under the Sehat Sahulat Card Programme at the DHQ hospitals of Punjab, bringing shame for the health department.

The report estimated that the DHQ hospitals of Punjab couldn’t get an approximate revenue of Rs645m that was to be paid under the UHI programme for providing treatment to the eligible (86,217) missed patients. This amount was estimated under Rs34pc of the total premium that was to go to the DHQ hospitals.

It further shared a breakup of the agreement signed between the State Life Insurance Corporation and the government, stating Rs22,000 was to be paid for each delivery, Rs32,000 for each C Section, Rs20,000 for surgery, Rs5,000 for indoor treatment and Rs5,000 for each dialysis under the UHI programme.

The said amount was to be distributed among doctors and other relevant staff as per the share formula besides the revenue that was to go to the hospital to be used under various heads including repair & maintenance, procurement of free medicines and to meet other expenses.

The government also faced a huge financial loss as the rest 64pc of other revenue from the total premium under UHI Programme was to be deposited with the national exchequer/treasury. This estimated amount was many times more in volume than the 34pc which was supposed to be given to the DHQ hospitals, according to the official report.

The report further unveiled the break-up of estimated annual ‘missed revenue impact’ the government and the DHQ hospitals of Punjab faced due to the failure of the Sehat Sahulat Card programme.

Out of the total Rs645m revenue loss all the DHQs faced for not giving coverage to 86,217 ‘missed patients’ under UHI programme during the specific period of July, Rs90m amount was assessed for delivery cases, Rs110m for the C Sections, Rs70m for surgeries, Rs320m for indoor treatment and Rs30m for dialyses.

It stated that out of the total Rs3bn revenue the DHQ hospitals couldn’t get, Rs440m was to be paid for deliveries, Rs570m for C Sections, Rs370m for different surgeries, Rs1bn for indoor services and Rs170m for dialysis of the patients.

Similarly, out of the total estimated annual revenue loss Rs9.2bn the government has to face for not providing coverage to the patients under Universal Health Insurance programme at all DHQ hospitals of Punjab, Rs1.2bn was to be obtained against deliveries, Rs1.6bn against C-Sections, Rs1.1bn against different surgeries, Rs4.6bn against indoor services and Rs500m against dialysis of the patients.

Some experts have declared the situation very alarming and pathetic at a time when the caretaker government is trumpeting much that it was sincerely making efforts to ensure healthcare services to the patients through the Sehat Sahulat Card.

They claim that as the universal health programme was launched during the tenure of the PTI government, some elements in the health authorities are making frequent deliberate efforts to politicise and defame it.

It was evident from the recent several controversies that surfaced when the government put a ban on C-Sections at the private hospitals and on the cataract surgeries due to misuse of lenses.

Earlier, it had also brought some more amendments to the Sehat Sahulat Card programme making it hard for the patients to get free treatment at the private hospitals across Punjab.

Published in Dawn, September 4th, 2023