To predict the future, especially when it comes to health and well-being, is not easy. Today, progress in the field of medical and health sciences is happening at an extraordinary pace, making possible what once was only a dream. This, however, has come at a cost – as medical expenses are also on the rise, making vital procedures and even general care at a reputable hospital unaffordable for the general population. In order to counter this, different health insurance companies bring to general public affordable and essential health plans that enable them to receive top-of-the-line healthcare without having to worry about financing it. Or so it works, at least in theory!
If you are married and have children, health insurance can lessen your medical expenditure and deliver better healthcare to your family. Flus, fevers and coughs are normal and may not seem like big issues, but what if you need a surgery that costs more than your monthly budget? When you have a health insurance policy you can opt to get treated at any of the network hospitals that are offered under your insurance provider’s agreement. Some insurance companies will even cover the expense for hiring an ambulance for the patient to travel from their home to the hospital or from one hospital to another. Health insurance companies are providing membership cards to their clients for cashless treatment, which allows an insured member to receive medical treatment from specified hospitals without a need to submit claims for or pay for treatment. Insurance companies are registered with large number of dispensaries clinics, general hospitals and pharmacies in their network.
Basic healthcare and diagnostic tests remain beyond the means of millions in Pakistan
But getting a health insurance policy with cashless facility to stay tension-free about any health-related expenditure is still a dream for the general public in Pakistan.
Miserably, quality healthcare in Pakistan has a huge price tag attached to it. Quality treatment is available only to rich, elite and privileged classes. People living in remote areas of Pakistan would would be willing to sell valuable possessions to get good healthcare at times – but there are major problems. They have to travel from their homes to specific hospitals, then suffer long waiting times for consultations and bear other costs to avail sufficient healthcare. The government’s spending of 3% of its GDP on healthcare system is woefully inadequate, as we all know. Medical care available to the mainstream population is sub-standard and the general attitude of most private hospitals is heartless and driven by greed.
Unfortunately, due to a lack of health awareness, a lack of basic health information and a lack of health insurance companies, a large number of deliveries during childbirth are conducted by traditional birth attendants at home, who are unable to manage the complications that may arise. Due solely to this, many mothers and newborn babies have to suffer complications. Patients, particularly those suffering from cardiac diseases, head to other countries for treatment.
Here, a major problem is not that we lack capable doctors and qualified paramedical staff. We have some of the best pediatricians, gynecologists, cardiologists, neurosurgeons, dermatologists, dentists and other important categories of medical specialists. Surprisingly Pakistan is exporting a very good number of young doctors, medical specialists and qualified medical and para-medical staff to the UK, USA, Canada and Middle East. The trouble is that we have not sorted out our priorities in terms of healthcare delivery. And that is reflected perhaps most in the fact that there is no well-developed health insurance system in Pakistan.
A good health insurance policy would generally cover expenses made towards consultation fees, costs towards radiological investigations, lab tests, ambulance charges, hospitalization costs and even post-hospitalization follow-up charges up to a certain period of time. In Pakistan, the following types of insurance policies can be promoted under the supervision of federal and provincial ministries of health:
Individual Health Insurance: This kind of policy covers the healthcare expenses and hospitalization charges of an individual who has purchased the policy. Generally, premium under this policy is determined as per the age of the insured person.
Family Medical Insurance Plan: Under this kind of policy, an individual can include all the family members, covering them against a wide range of diseases under a single solution. A family health plan offers a fixed sum assured for the family members, which can be availed by all members of the family or by any one individual of the insured family.
Senior Citizen Health Insurance Plan: This policy is designed especially for senior citizens, pensioners or individuals over 65 years of age offering protection from health issues during old age.
Insurance plans for surgical interventions and critical health problems: Such plans are suitable for the insured that require treatment against critical illness, such as kidney failure, paralysis, cancer, heart attack or other cardiac diseases etc. As the medical expenses for the treatment of these types of life-threatening illnesses are very high, the premium applicable to these types of insurance policies is also accordingly high.
Maternity Health Insurance Plan: This type of insurance policy covers costs, including pre- and postnatal care, normal vaginal delivery charges, cesarean section charges and expenses of newborn babies. It also covers for the newborn under the mother’s insurance card up to a certain period of time as mentioned in the plan. Ambulance costs are also covered.
“Accident at home” or “road traffic accident” plan: This type of policy covers hospitalization expenses in the event of an accident at home or on the road. The premium amount is dependent upon the amount of coverage taken.
Saving Linked Health Plans: These plans offer a unique combination of insurance and savings both at the same time. They can be used to meet those expenditures which are not covered by the insurance.
Most insurance companies are not covering internationally excluded items. Major exclusions are: self-inflicted injuries, sicknesses resulting from abuse of some medicines, stimulants, tranquilizers, alcohol and narcotics. Cosmetic treatment or surgery (unless necessitated by injury), hair loss, baldness or artificial hair are also not covered usually. Wars with other countries, invasions and civil wars are also not usually covered .Ionic radiation and contamination with radioactive materials resulting from nuclear fuel or nuclear wastes, as well as terrorist strikes, riots, or excessive use of force by police are not covered either.
To promote a health insured community for the people of Pakistan, federal and provincial governments should be bound by law. All private, semi-private and public-limited organizations would then have to provide a basic health insurance policy to all their employees. The government also can promote a health insurance culture in Pakistan by offering a deduction from income tax. Federal and provincial governments can give incentives to various public and private limited companies, industrial units and other business organizations in the shape of tax benefits. The premium paid on health insurance can be declared as exempted from tax.
This will not only help to promote health insurance culture in our communities but will also produce a snowball effect to create more job opportunities and to reduce unemployment by the development of health-insurance-providing institutions. This process will attract all national and multinational health insurance companies to offer suitable and affordable health insurance plans to private and public limited companies, firms, business organizations, groups, individuals and families.
All of this will have to begin as a process initiated by the government. But if healthcare in Pakistan is to be brought anywhere close to global standards, there is no other way out.
Dr. Faisal Khan is an M.B.B.S, MPH, MCPS (Scholar) currently based at the Al Dar Hospital, Madina Al Munawara, Saudi Arabia
