Providing health insurance cards to the poor doesn’t mean that they will use them, especially considering most people don’t even know all of the benefits that come with such cards.
The speakers at a conference organised by the Rural Support Programmes Network highlighted that people in Sindh have been quite hesitant of using their cards due to a lack of awareness.
The micro health insurance (MHI) cards allow people to consult certified professionals and receive quality medical care instead of relying on rural quacks. However, up until this February, only 0.7% of those issued these cards had actually utilised them.
“These schemes are meant for the poorest of the poor, so low literacy rates are a big issue,” said Dr Abdur Rehman Cheema, the team leader for research at RSPN. He pointed out that they even found a few MHI cards stuck in ATMs. “People thought they were cash cards.”
A WHO report says the cards we give are to people living below the poverty line who don’t seek medical treatment frequently, said Dr Sonia Riaz, the deputy director of the Prime Minister’s National Health Programme.
Many people don’t go to hospitals because they are quite far from their homes. Another issue is that most of these people migrate frequently and often relocate to areas where they aren’t insured.
“Our information hasn’t been communicated to the people properly.” She said that they met a person who had surgery done for a child and paid through the card. His wife was also pregnant but he didn’t know that the card covered maternity costs as well so her took his wife to another hospital and had to pay for her treatment.
There are hospitals that take advantage of patients who don’t know about their health insurance, said Dr Riaz.“There were instances where hospitals charged money in an underhanded manner and we had to remove them from our panel [of approved hospitals for medical insurance].” There is a need for medical audit and strict monitoring and evaluation, she added.
Sometimes the behaviour of the doctors and hospital staff can act as a deterrent too. Dr Faisal Abbas, a research fellow at Gottingen University Germany, cited a study from Kohat which highlighted that the attitude of hospital staff affected patient’s perceptions of hospitals and prevented them from returning.
The experts said that health cards have many advantages if they are used properly.
“Around 60% of cases where the cards were used were related to gynaecology, which is a good sign considering our high rates of maternal mortality,” said Dr Cheema. Thirty percent of the cards were used for viral illnesses such as diarrhoea.
The proximity of panel hospitals, such as ones in Jamshoro, also encouraged people to seek treatment. The availability of an insurance card meant that they did not need to resort to selling their livestock or property or be at the mercy of feudal landlords to pay their medical bills.
“Sixty percent of our health problems can be handled within the community,” said Dr Shehla Zaidi, the acting head of health policy and management at the Aga Khan University Hospital. Health insurance schemes will only work if they’re implemented with good primary care package, she remarked. “There is a need for community-based health interventions. Quality regulation is also very important.”
Health insurance schemes
The government’s Sehat Insaf Card initiative has overcome many problems associated with other health insurance cards. Dr Riaz said that this health card aims to provide universal health coverage to poor people by allowing easy access to free indoor health services similar to the MHI cards under a family package.
An advantage of the Sehat Insaf Card over other health insurance cards is that it also covers a patient’s transport costs and is linked with the NADRA database. The card also offers inter-district and inter-provincial portability. This means that people can easily seek treatment wherever they are.
The Sindh Union Council and Community Economic Strengthening Support (SUCCESS) programme, on the other hand, has been running since 2015 in eight districts of the province and will conclude in 2021. It received 82.13 million euros in funding from the European Union, of which four million euros were allocated for micro health insurance.
Under this scheme, micro health insurance cards (MHI) were issued to 131,000 households, the “poorest of the poor”, to cover in-patient costs of cardholders and their family members. Each household member had medical insurance worth Rs25,000 per year, of which the insurance company was paid Rs1,000 as premium for an average household of six people.