PESHAWAR: The Khyber Pakhtunkhwa government has decided to start enhanced payment to empanelled hospitals for cardiac procedures of patients treated on Sehat Card Plus from next month.

“This has been decided in a meeting held with Chief Minister Ali Amin Khan Gandapur in the chair to increase the rates of hospitals for treatment of cardiac patients,” Dr Mohammad Riaz Tanoli, the chief executive officer of Sehat Card Plus (SCP), told Dawn.

The meeting, also attended by finance adviser Muzzammil Aslam, decided to start paying Rs4 billion to State Life Insurance Corporation, the executor of the programme, per month on regular basis to implement the decision regarding enhanced payment to hospitals for heart surgeries and other procedures.

In July, Policy Board of SCP had granted approval to increase rates for cardiac procedures under the health insurance scheme by 40 per cent, but owing to financial issues, the decision could not be enforced, he said.

Govt decides to pay Rs4bn to executor of SCP per month on regular basis

Dr Riaz said that heart patients consumed 36 per cent of the total amount spent on treatment of people under SCP but hospitals had been demanding increase in rates due to rising costs of medical implants, medicines, diagnostic reagents and utility charges.

“With rise in the rates of cardiac procedures, the monthly expenditure of the programme will go up to Rs3.1 billion but patients would start getting treatment on regular basis,” he said. He added that upward revision of hospital fees for heart patients was a longstanding problem because rates had not been enhanced since 2018 while the prices had gone up manifold.

Dr Riaz said that so far Rs88 billion was spent on free treatment of 3,529,487 patients since 2016. There are 118 empanelled hospitals in Khyber Pakhtunkhwa and 635 across the country where 10.5 million families of the province are eligible to avail free healthcare services.

He said that higher payment to hospitals would benefit cardiac patients. He said that they had also planned to increase rates of treatment for orthopaedic patients owing to significant increase in implant prices and depreciation of rupee against the US dollar.

“Hospitals import implants in dollars. The decision would result in a 40 per cent hike in payments for 26 cardiac interventions under SCP,” said Dr Riaz.

He said that government so far paid Rs19.5 billion for free treatment of patinets since March in the current year whereas a similar amount was still unpaid. He said that hospitals had demanded an increase of over 50 per cent, arguing that the current rates were far less than the market’s, so it was difficult for them to carry ahead with services.

Dr Riaz said that currently around a dozen hospitals in the province were offering cardiac services under the SCP but low rates affected patients. “Now chief minister has issued strict directives to continue paying amount to insurance company so that the patients get smooth services. Cardiac procedures are very expensive and most patients cannot afford their cost,” he added.

He said that programme was meant to provide quality health services to people free of cost, so hiking procedure rates was imperative because it wanted the patients to be treated by highly qualified doctors.

Sources said that empanelled hospitals had not stopped providing services to heart patients but they were using delaying tactics because they were not ready to admit and treat patients on the existing charges.

They said that most heart patients had to wait for a long time to undergo procedures as hospitals falsely claimed to be without beds to admit them though the real issue was the lower rates offered by the government to them.

They said that some senior cardiologists and heart surgeons flatly refused to check and operate on patients under SCP as they earned more from treatment of private patients.

Published in Dawn, September 26th, 2024