PESHAWAR: To ensure transparency and quality services to patients under the Sehat Card Plus (SCP) initiative, private hospitals in Khyber Pakhtunkhwa have been barred from treating people with seven diseases, according to officials.

“The government has restricted appendectomy, cholecystectomy, caesarean delivery, tonsillectomy, cataract, angiography and septoplasty and SMR to public sector hospitals only. The measure is meant to put brakes on abuses of the free treatment programme by private outlets,” they said.

As the government is set to resume health services on SCP from first day of Ramazan, the private hospitals have been asked to refer patients with these seven health conditions to public sector hospitals for management.

“The decision has been made to stop abuses by the private hospitals and save public money,” said officials. The programme, which remained in limbo since October last year owing to shortage of money, will be streamlined with the passing of time to make sure that patients go to right hospitals and get good healthcare services.

Officials say the decision meant to stop misuse of SCP funds

In 2022, health department had inspected the record of few empanelled hospitals in the province. The record showed that some doctors operated on patients unnecessarily to get money. “Surgeons at one private hospital in Dir district has operated upon about 900 persons for appendicitis, many of them without fulfilment of protocols,” they said.

Officials said that surgeons had carried out appendectomies of more than one person in the same household. Such anomalies were hard to establish afterwards because the private hospital tested the patients before operations, suggesting they required surgery, they said.

They said that barring private hospitals from carrying out those procedures would not only save money to the government but would also protect patients against complications. Upon receiving complaints, government has two options, either to delete the diseases, which are being abused from the programme, or limit the same to public hospitals. “The latter option is feasible,” they said.

Officials said that other surgeons had been accused of carrying out caesarean section despite the fact that normal deliveries were possible but the surgeries were conducted to receive money from SCP funds.

They said that if operations of tonsils or gall stones were delayed for few days, nothing would happen, therefore, patients should go to public sector hospitals. There are 118 empanelled hospitals including 58 private outlets that can entertain patients with about 1,700 diseases and procedures.

“Private hospitals are allowed to admit patients with peptic ulcers, ICU care, intestinal obstruction, enlarge prostate and kidney stone etc. These measures have been recommended by the interim government,” said officials.

They said that private hospitals could also treat patients with orthopaedic, neurosurgical and cardiology problems.

“The treatment of these health problems is expensive but entails little chances of abuse. Private hospitals have also been asked to refer patients with these issues to public sector hospitals including medical teaching institutions,” they said.

Only in orthopaedics, there are more than 40 procedures, which can be conducted in private hospitals on SCP.

“The purpose of the cashless treatment initiative is to benefit people not private hospitals. Therefore, we are safeguarding interests of patients. So far, Rs76.5 billion has been spent on the treatment of three million patients since 2016 under the programme,” said official.

Of this amount, 60 per cent has gone to private hospitals. Public sector hospitals continue to improve performance. State-run hospitals received 13 per cent share in 2016 but lately they had been receiving 40 per cent patients on SCP, they said.

“With new restrictions on private hospitals, public sector health facilities will further improve their services and increase their income,” they said.

Published in Dawn, March 11th, 2024