The Khyber Pakhtunkhwa government plans to hold back part of the money public hospitals earn under the province’s free health insurance scheme, Sehat Card Plus, and is preparing to change the law to allow it.
Under the plan, the government would retain 20 per cent of the total income that public sector hospitals receive through the programme. Health Minister Khaliqur Rehman told Dawn that a presentation on the proposal, along with other steps to improve the scheme, had been given to Chief Minister Sohail Afridi, and that the plan would go to the provincial cabinet once finalised.
The government’s reasoning
Officials argue that public hospitals are paid twice. They already receive regular budgets from the provincial government, and doctors, nurses, paramedics and other staff draw government salaries. Hospitals also earn money from user charges for tests, admissions and operations.
“Public hospitals receive funds from government while doctors, nurses, paramedics and other employees receive salaries, therefore, deduction should be done from the income they generate through SCP,” sources in the health secretariat said.
They added that doctors and staff also earn through institution-based practice, while hospitals keep the whole of their Sehat Card income.
Why the law must change
The plan needs legal cover. Under the Khyber Pakhtunkhwa Universal Health Act, 2020, public hospitals keep “without loss of budget” all of the additional income they earn from the scheme. That money is meant to be used to improve the quality of healthcare and to pay incentives to hospital staff.
The health department has started work on a summary proposing amendments to the Act. These would need approval first from the cabinet and then from the provincial assembly.
Rehman said the plan also includes closer oversight of the programme, to make sure funds are used for deserving patients. “We want to further expand Sehat Card Plus services to local level,” he said, adding that the government had increased the programme’s budget from Rs35 billion in 2025 to Rs41 billion.
A decade of free health cover
Sehat Card Plus began in 2015, covering 3 per cent of the population in four districts. It grew to 51 per cent of residents in 2016 and 69 per cent in 2017, before becoming universal across the province in 2020.
| Programme in numbers | Figure |
|---|---|
| Families eligible | 10.6 million |
| Cover per family, per year | Up to Rs1 million |
| Patients treated so far | 5.7 million |
| Spent so far | More than Rs155 billion |
| Share paid to public hospitals | More than 50pc |
| Empanelled hospitals nationwide | About 1,000 |
The scheme is run through State Life Insurance Corporation. Residents of Khyber Pakhtunkhwa can receive free treatment on their national identity cards at empanelled public and private hospitals across the country, not only in their own province.
What it could mean for hospitals
Because public hospitals receive more than half of all Sehat Card spending, a 20 per cent deduction would reduce a significant source of income that the current law reserves for improving services and paying staff incentives. How the retained money would be used, and whether hospitals and their staff accept the change, will become clearer when the proposal reaches the cabinet and the assembly.
Healthcare funding and hospital staffing are under scrutiny elsewhere too. In Islamabad, the High Court has asked the medical regulator to recommend limits on doctors’ working hours, while repeated HIV cases linked to dialysis units in south Punjab have raised concerns about infection control in public hospitals.
Why it matters
Sehat Card Plus is one of the most ambitious public health programmes in the country, giving every family in Khyber Pakhtunkhwa free hospital care worth up to Rs1 million a year. How its money is shared between public hospitals and the provincial government will affect both the quality of care in those hospitals and the scheme’s long-term finances, which is why the proposed changes to the law will be closely watched.
This article draws on reporting published by Dawn.
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