PESHAWAR: For the first time, private hospitals in Khyber Pakhtunkhwa have recorded a decline in their share of income from the Sehat Card Plus health insurance programme, losing ground to government hospitals.

Official figures show that public hospitals earned more revenue from SCP than private hospitals last year, bringing in Rs15.37 billion compared to Rs7.695 billion for private hospitals, out of a total of Rs23.052 billion spent on treatments.

Public hospitals received 72 per cent of the patients (627,046), while the rest (249,640) were treated by private hospitals.

Officials said since 2016 when the programme was launched in the province, private hospitals had been consistently earning much more from the health insurance scheme.

Govt hospitals received 72pc of patients under scheme last year, show official figures

In the launch year, they admitted 3,016 patients (99pc) under SCP, while public hospitals’ admissions totaled 21.

Next year was no different as the private hospitals received 43,166 (76pc) patients and public sector treated 13,488 patients (24pc).

In 2018, 37,012 (65pc) sought treatment in private and 20,056 (35pc) in public hospitals, whereas the tally of patients at private hospitals remained 39,652 (72pc) and public’s 15,057 (28pc) in 2019.

Private hospitals recorded 60,558 patients (81pc) and government’s 14,514 (19pc) in 2020, while the number of patients visiting the former was 367,078 (68pc) and public hospitals 173,814 (32pc) in 2021.

The figures showed that the private hospitals continued its dominance in 2022 when they got 680,235 patients (60pc) and public ones 447,332 (40pc), while the next year, the former received 567,515 (52pc) patients under the SCP and public ones 529,877 (48pc).

As of Dec 31, 2024, private hospitals received Rs54.316 billion and public hospitals Rs44.664 billion under the health insurance programme.

However, the admission decline was reported by private hospitals in 2014 when the government restricted them from carrying out seven procedures, including appendectomy, cholecystectomy, caesarean delivery, tonsillectomy, cataract, angiography and septoplasty and SMR after many patients were found to be operated on without medical justification, according to officials.

They said besides placing restrictions on private outlets, the government also encouraged its hospitals to enhance admission under SCP to increase their revenue.

The officials said under the formula for distribution of income generated from SCP, the hospitals were required to spend 25 per cent of the funds to improve patient care, carry out minor repairs for maintenance, allocate 30 per cent for doctors and 20 per cent for consumables, give away 15 per cent to nursing and paramedical staff members, and keep 10 per cent for administrative cost.

They said nine-member committees were constituted at all hospitals with medical superintendent as heads, but the formula remained partially implemented despite instructions in 2020 to enforce it. Of late, the formula has been enforced as some hospitals are admitting 100 patients under SCP.

Officials said the “Fund Retention and Utilisation/Distribution Formula,” which remained partially implemented until 2022, was fully enforced in 2023, causing the flow of patients rise in public hospitals.

They said prior to the enforcement of the formula, government hospitals weren’t admitting patients under SCP like private hospitals for being unsure about their share in the revenue.

The officials said the government had decided to provide care to patients in public hospitals so the staff members could earn and the respective hospitals upgrade their services.

They said as the government had planned to resume organ transplants soon, there were agreements with Institute of Kidney Diseases and Hayatabad Medical Complex for renal transplants and expensive thalassaemia treatment.

The officials said an Islamabad-based private hospital had been selected for liver transplants as the facility wasn’t available in any public hospital in Khyber Pakhtunkhwa.

Published in Dawn, March 13th, 2025