PESHAWAR: The Khyber Pakhtunkhwa health department has decided about rate hikes for treatments covered under the Sehat Card Plus health insurance programme due to rising costs of medical implants, medicines, diagnostic reagents, and utility charges.

The decision was made during a recent meeting in which representatives of public and private hospitals and State Life Insurance Corporation informed health minister Syed Qasim Ali about the rising costs of implants and requested a revision of treatment rates under the government’s free healthcare initiative.

Sehat Card Plus chief executive officer Dr Mohammad Riaz Tanoli confirmed the development and said the meeting was held on the directives of Chief Minister Ali Amin Khan Gandapur to consider the demand of hospitals for increasing treatment rates.

He said the hospitals insisted that there had been no rise in those rates since 2018 while the implant, medicine and utility rates had gone up manifolds.

Official says decision made over rising costs of medical implants, diagnostic reagents, utility charges

Dr Tanoli said the rate hike was mostly benefit the hospitals performing cardiac procedures as the cost of imported stents and implants priced in dollars had gone up.

“We’ve so far spent 27 per cent of the Sehat Card Plus budget on heart patients,” he said.

The SCP chief said a committee comprising all stakeholders had been formed to discuss the issue and produce a report within three weeks.

He said rates for over 50 treatments would be considered for an increase, with cardiology being the top priority to ensure patients receive quality care.

“Our programme aims to cover the entire Khyber Pakhtunkhwa population in empaneled hospitals with no compromise on service quality,” he said.

Dr Tanoli said assessments were being carried out to ensure hospitals meet the registration criteria with non-compliant hospitals being de-listed.

He also said there was a strict criterion for hospital empanelment for the health insurance programme, while a complaint management system was also in place to act against hospitals found to be mistreating patients.

Other officials in the health department insisted that the decision was justified as many hospitals, while not outright denying services to patients, were using delaying tactics due to diminishing profit margins in Sehat Card Plus cases.

They said hospitals continued to charge rates agreed upon five years ago despite increases in gas, electricity, medicine, and diagnostic service costs.

A medical director, who attended the meeting with the health minister, noted that doctor fees had also increased over the last few years, so a rate hike for treatments under the SCP programme also warranted hike.

“Our cardiac surgeons use stents whose international prices continue to rise necessitating an upward revision of rates to ensure timely care so that patients don’t suffer,” he said.

The official anticipated at least a 30 per cent rate increase for cardiology services and other treatments.

He said hospitals were paying five times more in utility bills compared to five years ago, prompting the government to form a committee to consider their demand for rate hikes.

“With the new elected government in place, hospitals have started receiving their overdue payments and aim to continue services as usual, with a rate hike being their longstanding demand. Authorities acknowledge rising costs of implants and expenses making a rate increase likely,” he said.

Published in Dawn, May 19th, 2024