Healthcare financing remained complex problem that developing nations are faced with. Market failure often compels states to step in to administer and offer health services and goods to the citizens. However, lack of resources, double burden of diseases, population growth rate, unregulated private sector, budget constraint coupled with displaced priorities, inefficient use of obtainable health budget, weak tax base and administration and ignorance about alternative mechanisms are the few important factors making financing into healthcare more complex. These factors may well characterize health systems of various developing nations.
In Pakistan, public and private healthcare systems run in parallel. Presently, the public sector until led through the health ministry has devolved to the provinces in the country. The administrative and fiscal space of provinces have increased manifold with simultaneous rise in their responsibilities but is still deficient in health workforce and facilities relative to the citizens.
No doubt, the private sector in Pakistan is playing a major role in the healthcare services delivery. Majority of private hospitals, clinics and health related facilities are in the urban regions and are well equipped with new diagnostic facilities. Furthermore, public health spending offers a significant insight on Pakistan’s health performance.
Many foundations, societies, individual philanthropists, community affiliation, Islamic organizations and individual contribute to finance health in the country.
Economic experts revealed that the Government of Pakistan spends $37 per capita on health, which is lower than the WHO’s prescribed level of per capita $44. The total public health expenditure as percentage of GDP has risen to 0.45 percent in FY2016. The level of expenditure amounting Rs133.9 billion or 0.45 percent of GDP explains a rise of 17.2 percent over same period last year.
Experts also said that after the 18th Amendment, the health sector service delivery in the country has been a subject for the provinces; however; the federal government would continue to support the provinces this year as well by allocating an amount of Rs22.4 billion for vertical program.
During 2016-17, the federal government announced Rs24.951 billion budget for the National Health Services, Regulations and Coordination Division under the Public Sector Development Program (PSDP) for as many as 15 ongoing schemes and 3 new schemes. One of the three new schemes, however, is establishment of a cancer hospital in whose status has been un-approved for the last three years.
The Prime Minister’s Health Insurance Scheme under which insurance be given for tertiary health care from 2015 to 2018, the premium cost of the scheme would be Rs9 billion. The Government of Pakistan has planned to give loans on soft terms and conditions to the hospitals involved. Under the head of health affairs and services, a total of Rs12.10 billion has been allocated in the budget estimates FY2016-17 which is higher by Rs1.098 billion and Rs0.695 billion respectively when compared with the budget and revised estimates for the year FY2015-16.
A total of Rs10.195 billion would be spent for hospital services, and Rs1.467 billion on health administration while only Rs28 million would be spent for purchase of medical products, appliances and equipment. It is important that the federal government is offering support to provinces on programs counting expanded program on Immunisation, Maternal, Neonatal and Child Health Program along with programs for blinds and PM program for prevention and control of hepatitis.
The public sector healthcare facilities are operating in a pathetic way almost in the whole country and majority of teaching hospitals in Pakistan counting Pakistan Institute of Medical Sciences in the federal capital do not have modern equipment for a number of surgical and diagnostic procedures.
Presently, the country’s public health care system comprises of 1,167 hospitals, 5,695 dispensaries, 5,464 basic health units, 675 rural health centers, 733 mother and child health centers and allied medical professionals i.e. doctors, nurses, midwives and pharmacists. As of FY2016, there are 184,711 doctors, 16,652 dentists and availability of 118,869 hospital beds in Pakistan. The ratio of one doctor per 1,038 person, one hospital beds for 1,613 persons and one dentist for 11,513 persons explains a clear inadequacies chiefly in case of dentists and hospital beds.
Health experts believe that the federal government should invest in long-term healthcare strategies to accommodate patients living in miserable situation. Even 70 years after independence, the government did not allocate anything for transfer of modern technologies in the health sector.