PESHAWAR: The State Life Insurance Corporation is likely to resume emergency medical services under the Sehat Card Plus programme following the release of Rs2 billion funds by the government for it on Saturday.

The SLIC, the implementer of the SCP on behalf of the provincial government, had stopped the provision of free medical care to the people registered for the health insurance programme on Thursday.

It is likely to resume emergency medical services only on Monday, according to officials in the health department.

They said the insurer had suspended and resumed free medical care of the people under the SCP since the formation of the caretaker government in the province in January this year.

The officials said a notification issued on Oct 19 asked the hospitals empanelled for the SCP to stop admitting patients under the health insurance programme until further orders.

Officials say govt has released Rs2bn for health insurance programme

They added that the notification declared that the “SCP’s health desks” at hospitals would remain open for processing pending claims and that all private hospitals empanelled for the programme would refer new admission cases to public sector hospitals in the absence of free coverage. The officials said health officials met representatives of the insurance corporation on Saturday to persuade them for the resumption of free medical care.

They added that the insurer agreed to restart services after the government promised the payment of Rs2 billion.

The officials insisted that the finance department had released the said amount but it had yet to reach the SLIC leading to a little delay in the resumption of free healthcare.

“As soon as we receive the money in our account [from the finance department], we will resume services,” a source quoted the SLIC’s representatives as saying.

He told Dawn that the insurance corporation had conveyed to the government that it would provide “limited” medical care to the population as the money released by the government was too little for all services.

Officials said hopefully, free treatment would resume for emergency, cancer, appendicitis and dialysis patients on Monday with those suffering from other diseases being unable to benefit from the health insurance programme.

They said the government had to pay Rs17 billion to the insurer but the government had assured it of Rs4 billion payment in the first week of November to enable it to resume the provision of all free medical services to people.

The officials said the insurance company had to clear Rs11 billion dues of empanelled hospitals to ensure uninterrupted care of patients.

They said the government had already restricted seven most common surgical procedures at public sector hospitals to “save the cost” of the programme.

The officials said empanelled private hospitals had been barred from admitting patients for caesarean delivery, tonsillectomy, cholecystectomy, appendectomy, cataract, angiography and septoplasty and submucosal resection with all those procedures to be done by public sector hospitals only.

They said the decision to restrict treatment of those diseases at public sector hospitals only had been made on the recommendation of the provincial cabinet as private hospitals “misused” that care to generate income from the SCP.

“It will enable the SLIC to cut the monthly cost of the programme and pay arrears to the hospitals besides meeting the running cost of the programme,” an official told Dawn.

He said the government would halve the number of empanelled private hospitals to reduce expenditure.

The official said the huge payment backlog belonged to medical teaching intuitions, which had stopped free services under the Sehat Card Plus programme.

He said the insurer had to pay Rs2 billion to the Lady Reading Hospital, Rs1.4 billion to the Peshawar Institute of Cardiology, Rs600 million to the Hayatabad Medical Complex and Rs500 million to the Khyber Teaching Hospital Peshawar, and other sums of amounts to MTIs and district headquarters hospitals.

The official said the majority of 10 MTIs were unable to pay salaries to their employees due to the non-provision of funds by the government.

He added that most of those institutions had restricted their elective services to ensure the continuation of emergency services to the critically-ill and injured people.

Health officials complained that the province wasn’t getting funds from the centre causing the health insurance programme to suffer frequently to the misery of patients.

Published in Dawn, October 22th, 2023