Problems of Health Insurance Market in Pakistan

Presented to: Mr.
Imran Yasin
Problems of Health Insurance market in Pakistan
June 6, 2011
PREFACE
Assignments, Term reports and Internship programs are the vital teaching
techniques of University of the Punjab’s BBA Insurance & Risk Management
program. The aim of such activities is to develop a practical evaluation approach in
students along with their studies.
As an integral part of BBA studies, every student has to make research reports.
In order to fulfill this purpose for Health and Disability Insurance subject we
selected “Problems of health insurance market in Pakistan” as are research topic.
We are thankful to our respectable teacher Mr. Imran Yasin who gave us the
chance to make this report.
We have tried our best to make this report comprehensive to provide information
about the strategic and functional problem areas of Health Insurance Market in
Pakistan. We have illustrated differences between four Asian countries to
demonstrate the heath care pros and cons.
Authors
A, Mi06
S, Mi07
K, Mi07
M, Mi07
M, Mi07
H, Mi07
June 6, 2011
ACKNOWLEDGEMENT
“We bow our heads in gratitude to almighty Allah, Who blessed

us with the ability and energy to complete this work.”
The guidance of Holy Prophet (S.A.W.W) is the continuous source of help for us
in what so ever field we are. Through the blessing of God and the spiritual efforts
of the Holy Prophet (S.A.W.W) we have been successful in completing this report.
We wish to express our deep sense of gratitude to our honorable and loving teacher
Mr. Imran Yasin for his friendly behavior. He provided us guidelines to achieve
our target. During the assignment whenever we faced any problem he said
welcome to us and solved our problem.
Authors
A, Mi06
S, Mi07
K, Mi07
M, Mi07
M, Mi07
H, Mi07
June 6, 2011
Table of Contents
Sr. No Topic Page
1 Preface and Acknowledgement 2-3
2 Introduction to Health Insurance 5
3 Health Insurance in Pakistan 9

 Insurance in Pakistan 10
 Economy of Pakistan 11
 Public Health Care System 12
 Pakistan Health Insurance System 15
 Private Health Care System 17
4 Problems of Health Insurance Market in 23

Pakistan
5 Comparison 26
6 Pakistan 32
7 India 38
8 China 40
9 Bangladesh 49
10 Recommendations
11 Conclusion 52
12 Bibliography 54
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Introduction
of
Health Insurance
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Health Insurance
Health insurance is insurance against the risk of incurring medical expenses. By

estimating the overall risk of health care expenses, an insurer can develop a routine
finance structure, such as a monthly premium or payroll tax, to ensure that money
is available to pay for the health care benefits specified in the insurance agreement.
The Greeks and Romans introduced the origins of health and life insurance in 600
AD when they organized guilds called "benevolent societies" which cared for the
families and paid funeral expenses of members upon death
Before the development of medical expense insurance, patients were expected to

pay health care costs out of their own pockets, under what is known as the fee-for-
service business model. During the middle to late 20th century, traditional
disability insurance evolved into modern health insurance programs. Today, most
comprehensive private health insurance programs cover the cost of routine,
preventive, and emergency health care procedures, and most prescription drugs,
but this is not always the case.
A health insurance policy is a contract between an insurance company and an

individual or his sponsor (e.g. an employer). The contract can be renewable
annually, monthly or be lifelong. The type and amount of health care costs that will
be covered by the health insurance company are specified in advance, in a member
contract or "Evidence of Coverage" booklet. The individual insured person's
obligations may take several forms:
 Premium: The amount the policy-holder or his sponsor (e.g. an employer)

pays to the health plan to purchase health coverage.
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 Deductible: The amount that the insured must pay out-of-pocket before the
health insurer pays its share. For example, policy-holders might have to pay
a 500 deductible per year, before any of their health care is covered by the
health insurer. It may take several doctor's visits or prescription refills before
the insured person reaches the deductible and the insurance company starts
to pay for care.
 Co-payment: The amount that the insured person must pay out of pocket
before the health insurer pays for a particular visit or service. For example,
an insured person might pay a 45 co-payment for a doctor's visit, or to obtain
a prescription. A co-payment must be paid each time a particular service is
obtained.
 Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a
co-payment), the co-insurance is a percentage of the total cost that insured
person may also pay. For example, the member might have to pay 20% of
the cost of a surgery over and above a co-payment, while the insurance
company pays the other 80%. If there is an upper limit on coinsurance, the
policy-holder could end up owing very little, or a great deal, depending on
the actual costs of the services they obtain.
 Exclusions: Not all services are covered. The insured are generally expected
to pay the full cost of non-covered services out of their own pockets.
 Coverage limits: Some health insurance policies only pay for health care up
to a certain amount. The insured person may be expected to pay any charges
in excess of the health plan's maximum payment for a specific service. In
addition, some insurance company schemes have annual or lifetime
coverage maximums. In these cases, the health plan will stop payment when
they reach the benefit maximum, and the policy-holder must pay all
remaining costs.
 Out-of-pocket maximums: Similar to coverage limits, except that in this
case, the insured person's payment obligation ends when they reach the out-
of-pocket maximum, and health insurance pays all further covered costs.
Out-of-pocket maximums can be limited to a specific benefit category (such
as prescription drugs) or can apply to all coverage provided during a specific
benefit year.
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 Capitation: An amount paid by an insurer to a health care provider, for

which the provider agrees to treat all members of the insurer.
 In-Network Provider: A health care provider on a list of providers
preselected by the insurer. The insurer will offer discounted coinsurance or
co-payments, or additional benefits, to a plan member to see an in-network
provider. Generally, providers in network are providers who have a contract
with the insurer to accept rates further discounted from the "usual and
customary" charges the insurer pays to out-of-network providers.
 Prior Authorization: A certification or authorization that an insurer provides
prior to medical service occurring. Obtaining an authorization means that the
insurer is obligated to pay for the service, assuming it matches what was
authorized. Many smaller, routine services do not require authorization.
 Explanation of Benefits: A document that may be sent by an insurer to a
patient explaining what was covered for a medical service, and how payment
amount and patient responsibility amount were determined.
Prescription drug plans are a form of insurance offered through some employer
benefit plans where the patient pays a copayment and the prescription drug
insurance part or all of the balance for drugs covered in the formulary of the plan.
Such plans are routinely part of national health insurance programs.
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Insurance In Pakistan
Pakistan which is officially called the Islamic Republic of Pakistan is located in

South Asia, in the heart of the ancient Indus Valley, bordering Afghanistan, Iran,
India, and China.
Due to the intense and ongoing fighting, between the various Islamic militant
groups and the government, Pakistan is considered unstable and a dangerous place.
Terrorism is alive and insurgent activities such as: suicide bombings, shooting in
the middle of public streets, political assassinations, hostage taking, and
countrywide sectarian violence between Sunni and Shia Muslims have been taking
place within this country. It is therefore important to put in place a medical health
insurance plan for oneself and one’s family in case of an emergency.
Status of health insurance industry in Pakistan
In Pakistan, health insurance business has historically been conducted as a non-

core line of business by most of the major insurance companies. Allianz EFU was
the first, and so far, the only ‘specialized’ Health Insurance company in Pakistan.
As a whole, the Health Insurance Industry in Pakistan is still in its infancy stages.
The insurance awareness levels in Pakistan have been very low, in general. Health
insurance is an even newer concept.
The overall penetration of health insurance in Pakistan is merely around 0.5% of

the total population which is very low. This seems particularly low if one takes into
account the poor general level of healthcare facilities available to the population
and the absence of any meaningful government funded health insurance programs.
As medical consumerism grows, the prevention & wellness should already be a

high priority for everyone.The increase in awareness would bring more quality
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consciousness. Secondly, medical advancement would introduce newer diagnostic

and curative procedures which may result in higher treatment cost. The average
consumer would therefore look for alternate ways to acquire more cost effective
yet good quality healthcare.
Private health insurance schemes provide a straight-forward vehicle of managing

uncertain & high medical bills through small regular savings. It is highly likely that
enhanced awareness coupled with higher cost may lead to more people opting for
private health insurance.
Economy of Pakistan
Pakistan, a developing country, had an estimated GDP of $449.3 billion in 2009.

The economy of Pakistan is the 27th largest economy in the world in terms of
purchasing power, and the 45th largest in absolute dollar terms. Pakistan has a
semi-industrialized economy, which mainly encompasses textiles, processing,
agriculture and other industries. Growth poles of Pakistan's economy are situated
along the Indus River. Pakistan has suffered from decades of internal political
disputes and low levels of foreign investment. Between 2001- and 2007, however,
poverty levels decreased by 10%, as Islamabad steadily raised development
spending. Between 2004 and 2007, GDP growth in the 5-8% range was spurred by
gains in the industrial and service sectors despite severe electricity shortfalls.
Growth slowed in 2008 and unemployment began to rise. Inflation remains the top
concern among the public, jumping from 7.7% in 2007 to 20.8% in 2008, and
leveling off at 14.2% in 2009. In addition, the Pakistani rupee has depreciated
since 2007 as a result of political and economic instability. The government agreed
to an International Monetary Fund Standby Arrangement in November 2008 in
response to a balance of payments crisis, but during 2009 its current account has
strengthened and foreign exchange reserves have stabilized, largely because of
lower oil prices and record remittances from workers abroad. Textiles account for
most of Pakistan's export earnings, but its failure to expand a viable export base for
other manufactures have left the country vulnerable to shifts in world demand.
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Other long-term challenges include expanding investment in education, healthcare,

and electricity production, and reducing dependence on foreign donors.
 Public Health Care System
Pakistan has a centralized health care system. The Government takes responsibility
to provide free medical treatment to all citizens in need for health care services.
The governmental institutions involved in the health policy process include the
Federal Ministry of Health and several planning and approval institutions. The
Federal Ministry of Health consists of one division and eighteen departments.
These departments are situated in different cities but work under the supervision of
the Health Division in Islamabad. The Federal Ministry of Health is responsible for
health legislation, quality of health care, health planning and coordination of health
related activities. The Ministry is also responsible for educational standards in the
field of medicine as well as nursing, dental, pharmaceutical, and paramedical
professions. In addition, the Ministry takes care of the provision of educational
facilities for backward areas and admissions in all the state-owned medical
colleges. The Ministry is also involved in the collection of health statistics.
Although the Federal Ministry of health is formally responsible for all these
interventions, the realization of these tasks is strongly dependent upon other
governmental bodies such as the Planning and Development Division (P&D
Division), the National Economic Council (NEC), the Executive Committee
of the National Economic Council (ECNEC), the Economic Coordination

Committee of the Cabinet (ECC), and Provincial Developmental Working Party
(PDWP).
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Levels of Health Care:
Delivery of health care in the Pakistani system is basically a referral system from
the villages to the cities. The public sector comprises more than 10,000 health
facilities including dispensaries (pharmacies), Basic Health Units (BHUs) and
Rural Health Centers (RHCs) in the villages, Tehsil Headquarters (THQ) hospitals
which function as secondary health care facilities, and District Headquarters
(DHQ) hospitals that serve the role of tertiary care units. At present a BHU covers
around 10,000 people whereas the larger Rural Health Centers (RHCs) cover
around 30,000 to 45,000 people. In Pakistan, Primary Health Care (PHC) centers
comprise both BHUs and RHCs. The Tehsil Headquarters Hospitals cover the
population at the sub-district level, where as the District Headquarters Hospitals
serve the entire district. Currently there are 22 tertiary care facilities in Pakistan, all
of which are mostly teaching institutions located in the major cities.
Primary Health Care Centers:
Including Maternal and Child Health Centers (MCHC), Basic Health Units (BHUs)
and Rural Health Centers (RHCs). There is at least one PHC center present in each
of the Union Councils, which serves between 10,000 to 25,000 people. MCHCs
and BHUs are supposed to operate from 8am to 3pm, Monday through Saturday,
while RHCs are supposed to provide 24-hour services. That being said, most of
these facilities are typically only operational for 3-5 hours each day. There are
1,084 MCHCs in Pakistan which are managed by Lady Health Visitors (LHVs)
and provide basic ante-natal care, normal delivery, post-natal and family planning
services, as well as treatment of minor ailments to women and children. There are
5,798 BHUs and Secondary Health Centers (SHCs) in Pakistan, which are
generally staffed by 10 health care workers consisting of a male doctor, a LHV, a
male medical technician and/or a medication dispenser (pharmacist), a midwife
(dai) of variable training, a sanitary inspector, a vaccinator, and 2-3 support staff
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(guard, sweeper, gardener, etc.). They are required to offer first level curative,
maternal and child health, family planning, and preventive care services. Pakistan
has 581 RHCs that provide more extensive outpatient services as well as some
inpatient services, though these services are usually limited to short term
observation and treatment of patients who are not expected to require transfer to a
higher-level facility. They serve a population of about 50,000 to 100,000 people,
with about 30 staff including two male medical officers, a female medical officer, a
dental surgeon and a number of paramedics. They typically have 10 to 20 beds, x-
ray equipment, a laboratory and minor surgery facilities. These facilities do not
include delivery and emergency obstetric services however.
Referral Level Care Facilities:
There are a total of 947 Tehsil Headquarters (THQ – sub district units) and District
Headquarters (DHQ) Hospitals that are located at respective levels and offer first
line referral services. Tehsil Headquarters Hospitals (THQH) serve approximately
100,000 to 300,000 people. They typically have 40 - 60 beds and support services
including x-ray, laboratory and surgery facilities. The staff consists of at least three
specialists: an obstetrician/gynecologist, a pediatrician, and a general surgeon.
District Headquarters Hospitals (DHQH) serve a catchment population of about 1

to 2 million people and typically have about 100-150 beds. These facilities
typically utilize a minimum of eight specialists, including an obstetrician and
anesthetist, although do not provide comprehensive emergency obstetric care.
Tertiary Care Facilities:
There are 22 tertiary care facilities in Pakistan. They also provide sub-specialty
care. These hospitals mainly provide curative services and to a limited extent some
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preventive services. The majority of the communities have access to a primary care
facility within a radius of 5 km. While access to government health facilities is
generally good, the utilization levels are low. Several surveys have consistently
shown that about 80% of clients seek care from the private sector and only 20%
visit the government managed facilities for ambulatory care, which is indicative of
considerable under-utilized capacity within the system.
 Pakistan Health Insurance System
Although Pakistan Health Insurance system is not as much developed; Government

of Pakistan with the help of USAID and foreign banks is working a lot in order to
promote it.
Health Policy of the Government Vision:
The vision of the National Health Policy is to improve the health and quality of life
of all Pakistanis, particularly women and children, through access to essential
health services.
Goal:
The goal of the national health policy is to remove barriers to access to affordable,
essential health services for every Pakistani.
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Policy Objectives:
To achieve the above stated goal of removal of barriers to essential health services,
the Government of Pakistan adopts the following six Policy Objectives to reform
and strengthen critical aspects of its health systems to enable it to:
1. Provide and deliver a basic package of quality essential health care services
2. Develop and manage competent and committed health care providers
3. Generate reliable health information to manage and evaluate health services
4. Adopt appropriate health technology to deliver quality services
5. Finance the costs of providing basic health care to all Pakistanis
6. Reform the health administration to make it accountable to the public
The Ministry of Health recognizes that provinces have varied needs and
expectations regarding health and that each Department of Health is fully capable
of identifying as well as delivering appropriate health care to their populations. It is
in this spirit that the federal ministry will support and facilitate the provinces in
implementation of their strategies by providing relevant financial and technical
resources to ensure that the essential health service package is accessible to all
citizens. The national health policy has been formulated with the primary objective
of resonating with the expectations of Provinces. It is designed to contribute to
advancing and strengthening the provincial health strategies.
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 Private Health Care System
The private sector in Pakistan is varied with no defined structure and weak
regulation exists in this sector.
Health Infrastructure:
The private sector health infrastructure is not well organized. There is a wide range
of disparity in health care provision in the private ranging from Hi-Tech hospitals
with all the necessary provisions to general stores providing unauthorized
healthcare services.
Private hospitals:
There are few regular hospitals in the private sector, which are fully equipped with
necessary supplies & equipment, transportation and skilled staff, and can be
compared to any teaching hospital of the public sector. Such hospitals are generally
privately owned businesses. The running costs are offset by the monthly income
generated as they charge a fee for service. Deemed business, there is no central
depository of information regarding these hospitals. Being under private
ownership, financial and business records are not available to the public. The
anecdotal information about the conditions of these hospitals leads to the
conclusions that the majority of the hospitals in the private sector are under staffed,
lack drugs and supplies, adequate patient transportation, qualified staff and modern
equipment. Under such conditions, the services provided by private sector
hospitals should not be relied upon, yet about 80% of the population is seeking
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services from the private sector. This is mostly due to the fact that the public is
unaware of the quality and standard of the services which they are being provided.
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Problems of Heath Insurance Market

in Pakistan
1. With a population of 149 million growing by 1.9% per year, Pakistan is ranked
138 of 173 countries covered by the United Nations Development Programme
(UNDP) human development index. It falls under "low human development."
2. Average growth of gross domestic product (GDP) was 4.6% in the 1990s,
against 6.5% in the 1980s. Over the last four years, economic growth has increased
robustly, from 5.1% in FY2003 to 6.4% in FY2004, and jumping to 8.3% in
FY2005.4 However, growth has not always led to poverty reduction. Periods of
high economic growth have witnessed declines in poverty, as in the 1980s, but also
increases, as in the 1960s. Periods of low economic growth have seen poverty
sharply increase, as in the 1990s, but also fall, as in the 1970s.5 Poverty was
around 32% in 2001 (latest figure available).
3. Even though there is much need for it, social protection is limited in all five
areas identified by the ADB social protection strategy. To help the poor, however,
the federal and provincial governments, nongovernment organizations (NGOs),
and the private sector are:
i. improving governance in public sector institutions,

ii. creating jobs and income-generating opportunities,
iii. strengthening social safety net systems,
iv. improving access to basic services.
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4. Total expenditure on social protection represents around 2% of GDP, of which

90% is on social insurance and health care for selected groups, 5.3% of the poor
receive some form of social protection, and around 10.0% of total social
expenditure goes to the poor.
5. Formal social security systems are restricted to civil servants, the army, the
police, as well as some formal sector enterprises (with five or more employees).
These schemes cover less than 3% of the total employed labor force. There are
hardly any informal, traditional, community-based insurance arrangements (for
example micro-insurance). There is also a gender and rural-urban bias in social
protection schemes.
6. One major pillar of any social protection network is access to free or affordable
health care. Major health incidents, especially those of catastrophic dimensions,
may aggravate households’ poverty or even bankrupt families. "The development
of the private health sector is also constrained by the low level of development of
the health insurance industry. The lack of access to health insurance poses a major
problem for the financing of care for catastrophic episodes of illness and injuries."6
Risk pooling, for example through health insurance, may prevent households from
falling into poverty, and those who are already poor will have the chance to get
access to better health services. Health insurance thus greatly helps reduce and
prevent poverty. Even when health insurance does not pay for services, it can
negotiate prices for health care and thus make the costs of services more
transparent. At several levels, health insurance became an issue in Pakistan. The
federal Ministry of Health is discussing how else to extend coverage of health
insurance. The government of Punjab has installed a task force to look into the
feasibility of providing health insurance for more people. Interest in the subject is
thus increasing.
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7. In general, public health expenditure is very low in Pakistan (3.5% of the public
budget is spent on health, and public health expenditure is 0.7% of GDP). National
public expenditure on health is $4 per capita, while total expenditure on health is
$18 per capita. This shows the high share of private health care spending, including
by households, which accounts for 75.6% of health care expenditure.7 Social
health insurance covers only 5% of the population but represents about 40% of
federal and provincial governments spending on health.
8. The health care financing system consists of three alternative protection

schemes, where health insurance still represents a small segment. The public has
access to the public system financed by the federal and provincial governments.
Public health care facilities comprise basic health units, rural health centers, and
public hospitals. Although public health care is supposed to be free, problems
encountered are:
i. frequent unofficial charges,

ii. lack of drugs and supplies (which have to be bought outside by the patients),
and
iii. absenteeism of staff.
9. Employees in the formal sector are covered by the social security health
insurance system (Employees Social Security Institution). The formal sector
includes employees of private companies with a minimum number of employees
(the number differs by province, from 5 to 10) and their families. These social
security institutions operate health facilities at the province level. With many
facilities in rented buildings and the better ones in newly built facilities owned by
the social security institutions, the quality of the facilities varies but is better than
in the public sector.
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10. Private insurance companies also offer health insurance. Despite the high cost,
private insurance companies have filled a market segment purchasing and
providing quality health care mainly as an employee benefit for private companies,
because federal and provincial governments health services are so poor. Group
health insurance is offered by seven insurance companies, and individual health
insurance by one insurance company (Allianz EFU). Because of the high expense,
large companies self-insure or provide their own medical facilities for employees.
11. The poor receive some assistance mainly financed by two autonomous
institutions—the Zakat fund8 ($133 million disbursed in 2003) and Bait-Ul-
Maal9 ($38 million disbursed in 2003). The Zakat fund supports hospitals, which,
in turn, help the eligible poor. Bait-Ul-Maal reimburses claims to those who have
applied for assistance and are found to be eligible. Both funds, however, can only
serve a small portion of the 50 million poor.
12. Those who do not avail themselves of health insurance or of the two funds,
and do not want to use public providers because of their low quality, have to buy
health care from private providers (doctors, dentists, clinics, hospitals, and
pharmacies) or from the many traditional healers and quacks, especially in the rural
areas. Even the poor frequently use private providers, which explains the high
share of health expenditure from private households.
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The comparison is done between four Asian countries to show the

differences between their health systems. The countries are:
Pakistan
India
China
Bangladesh
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The World Health

Organization's ranking of the
world's health systems.
88 Bangladesh
112 India
122 Pakistan
144 China
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Doctors Per
Country 1000 Pop
China 2
Pakistan 0.6
India 0.4
The following table is compiled from the data in the World Health Organization Statistical
Information System.
Total Expenditure on Health as % of GDP 2000-2005
India 4.3 4.6 4.8 4.8 4.9 5

Pakistan 2.5 2.3 2.3 2.2 2.2 2.1
Bangladesh 3.1 3.2 3.1 3.1 3.1 2.8
China 4.6 4.6 4.8 4.8 4.7 4.7
Ministry of Pakistan states that health expenditure of period 2007-08 was 3.791 billion Pakistani
rupees while that spent on development was 14.272 billion.
 PAKISTAN
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Infant mortality rate: total: 63.26 deaths/1,000 live births

male: 66.52 deaths/1,000 live births
female: 59.85 deaths/1,000 live births
Yea Ran
Infant mortality rate Percent Change Date of Information
r k
2003 76.53 33 2003 est.
2004 72.44 36 -5.34 % 2004 est.
2005 72.44 37 0.00 % 2005 est.
2006 70.45 37 -2.75 % 2006 est.
2007 68.84 33 -2.29 % 2007 est.
2008 66.94 32 -2.76 % 2008 est.
2009 65.14 32 -2.69 % 2009 est.
2010 65.32 27 0.28 % 2010 est.
2011 63.26 25 -3.15 % 2011 est.
This entry gives the number of deaths of infants under one year old in a given year per 1,000 live births in the same
year; included is the total death rate, and deaths by sex, male and female.
Source: CIA World Factbook - Unless otherwise noted, information in this page is accurate as of March 11, 2010
The average age in pakistan is 65.5 years
Social Policy Development Centre (SPDC), 2004, demonstrates that out of every
1,000 children who survive infancy, 123 die before reaching the age of five. A
large proportion of those who surviving suffers from malnutrition, leading to
impaired immunity and higher vulnerability to infections.
Malnutrition is big problem in Pakistan. Human Conditions Report (2003) clearly

points out that about 40 percent children under 5 year of age are malnutrited.
About 50 percent of deaths of children under 5 years old children
are due to malnutrition.
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Personnel:
According to official data, there are 127,859 doctors and 12,804 health facilities in the country to
cater for over 170 million people
Personnel
Doctors (2009) 139,555
Dentists (2009) 9,822
Nurses (2009) 69,313
Midwives (2009) 26,225
Health visitors (2009) 10,731
Registered vets (2009) 4,800

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Physicians are registered. The traditional medicine has been acceoted and
integrated into the national health system in pakistan.
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In general, public
health expenditure is very low in Pakistan (3.5% of the public budget is spent on
health, and public health expenditure is 0.7% of GDP). National public expenditure
on health is $4 per capita, while total expenditure on health is $18 per capita. This
shows the high share of private health care spending, including by households,
which accounts for 75.6% of health care expenditure.7 Social health insurance
covers only 5% of the population but represents about 40% of federal and
provincial governments spending on health. The health care financing system
consists of three alternative protection schemes, where health insurance still
represents a small segment. The public has access to the public system financed by
the federal and provincial governments. Public health care facilities comprise basic
health units, rural health centers, and public hospitals. Although public health
June 6, 2011
care is supposed to be free, problems encountered are (i) frequent unofficial

charges, (ii) lack of drugs and supplies (which have to be bought outside by the
patients), and (iii) absenteeism of staff.
Health Insurance and Employees Social Security Third–Party health insurance is

rare in Pakistan covering only a few upper-income people. But the Employee
Social Security Institution (ESSI) system is a direct provider scheme that is
employer-financed and has about one million registered members. The same
system can be strengthened and extended to all industrial units and business
enterprises. The medical coverage provided in the public health sector has
remained inadequate for the population in general and the government employees
in particular. Although the government’s health expenditure on providing services
of various kinds including treatment abroad is quite substantial, the health
establishments in the country have always remained grossly inadequate in catering
the medical needs of the government employees.
According to the Economic Survey of Pakistan (2007 - 2008), the government

spent 0.57% of GDP on health sector in order to make its population healthier.
Health expenditures in absolute terms have more than the doubled percentage
during the last few years; from Rs. 25 billion in 2001 - 2002 to Rs. 60 billion in
2007 -2008. However, health expenditure as a percentage of GDP does not present
a reasonable representation as it has remained stagnant
 INDIA
With one of the fastest growing economies in the world, clocked at a growth
rate of 8.3% in 2010, India is fast on its way to becoming a large and globally
important consumer economy. The Indian middle class, estimated to be 50 million
people. If current trends continue, Indian per capita purchasing power parity will
significantly increase from 4.7 to 6.1 percent of the world share by 2015. In 2006,
22 percent of Indians lived under the poverty line. India aims to eradicate poverty
by 2020.
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The standard of living in India shows large disparity. For example, rural areas of
India exist with very basic (or even non-existent) medical facilities, while cities
boast of world class medical establishments. Similarly, the very latest machinery
may be used in some construction projects, but many construction workers work
without mechanization in most projects.
In 2010, the per capita PPP-adjusted GDP for India was US$3,290.
India has a universal health care system run by the local (state or territorial)
governments. Government hospitals provide treatment at taxpayer expense. Most
essential drugs are offered free of charge in these hospitals. However, the fact that
the government sector is understaffed underfinanced and that these hospitals
maintain very poor standards of hygiene forces many people to visit private
medical practitioners.
The charges for basic in-hospital treatment and investigations are much less
compared to the private sector but the private sector is also very cheap. It is also
possible for poor people to go to a private doctor's clinic run out of the doctor's
home and get treatment for a very small fee. The cost for these subsidies comes
from annual allocations from the central and state governments. For example, an
outpatient card at AIIMS (one of the best hospitals in India) costs a one-time fee of
10 rupees (around 20 cents U.S.) and thereafter outpatient medical advice is free.
In-hospital treatment costs depend on financial condition of the patient and
facilities utilized, but are usually much less than the private sector. For instance, a
patient is waived treatment costs if their income is below the poverty line. Another
patient may seek an air-conditioned room for an additional fee.
Primary health care is provided by city and district hospitals and rural primary
health centre’s (PHCs). These hospitals provide treatment free of cost. Primary
care is focused on immunization, prevention of malnutrition, pregnancy, child
birth, postnatal care, and treatment of common illnesses. Patients who receive
specialized care or have complicated illnesses are referred to secondary (often
located in district and taluk headquarters) and tertiary care hospitals (located in
district and state headquarters or those that are teaching hospitals).
June 6, 2011
Now organizations like Hindustan Latex Family Planning Promotional Trust and
other private organizations have started creating hospitals and clinics in India,
which also provide free or subsidized health care and subsidized insurance plans.
The government-run healthcare suffers from a lack of hygiene and India's ruling
class avoided the government hospitals and went to Western countries for
treatment. With the advent of privatized healthcare, this situation has changed
Insurance in india:
Insurance is a subject listed in the concurrent list (where both centre and states can
legislate) in India. The insurance sector has gone through a number of phases and
changes. Since 1999, when the government opened up the insurance sector by
allowing private companies to solicit insurance and also allowing foreign direct
investment of up to 26%, the insurance sector has been a booming market.
However, the largest life-insurance company in India is still owned by the
government.
In India, insurance has a deep-rooted history. Insurance in various forms has been
mentioned in the writings of Manu (Manusmrithi), Yagnavalkya (Dharmashastra)
and Kautilya (Arthashastra). The fundamental basis of the historical reference to
insurance in these ancient Indian texts is the same i.e. pooling of resources that
could be re-distributed in times of calamities such as fire, floods, epidemics and
famine. The early references to Insurance in these texts has reference to marine
trade loans and carriers' contracts.
Insurance in its current form has its history dating back until 1818, when Oriental
Life Insurance Company was started by Anita Bhavsar in Kolkata to cater to the
needs of European community. The pre-independence era in India saw
discrimination between the lives of foreigners (English) and Indians with higher
premiums being charged for the latter. In 1870, Bombay Mutual Life Assurance
Society became the first Indian insurer.
June 6, 2011
Industry structure:
Currently, a US$41 billion industry, India is the world's fifth largest life insurance
market and growing at a rapid pace of 32-34% annually as per Life Insurance
Council studies.
Currently, in India only two million people (0.2 % of the total population of 1
billion) are covered under Mediclaim, whereas in developed nations like USA
about 75 % of the total population are covered under some insurance scheme. With
more and more private companies in the sector, the situation may change soon.
Future of Indian insurance market:
India is the fifth largest insurance market in Asia. In 2004, Indian insurance
premium size increased by 17.2% to $21 billion. Similar to other Asian markets,
life insurance contribution in the total insurance business is significantly high in
India, increasing marginally to 79.62% in 2004 from 79.55% 2003.
Liberalization of the insurance market, increasing competition, the introduction of

innovative products and rising income, have all led to the phenomenal growth in
total insurance premiums. In India, both domestic and foreign private players are
allowed to operate insurance businesses. Public players, which had a monopoly in
the insurance business, have started facing stiff competition from private
companies.
Non-life insurance held 20.37% of the total business in 2004. The poor growth in
non-life insurance business is mainly due to the low awareness level and the tariff
structure. A premium tariff still widely applies to non-life insurance, restricting its
growth.
June 6, 2011
2004, India accounted for around 6.61% of Asia’s GDP, and was world’s second
most populous country. However, insurance penetration in India is only 2.82%
which works out 2.45% in life and 0.62% in non-life business. Despite its vast
population, rural poverty and a lack of insurance awareness have prevented the
proliferation of insurance products in the past. However, with the opening up of the
market, the scenario is set to change. Improvements on the supply side will help
boost penetration.
Comparison Data:
India's economy has grown more rapidly than Pakistan's in the last ten years.
However, both nations have accepted and implemented significant economic
reforms that have opened up their economies and brought about rapid growth,
more than doubling the size of each economy in the last ten years.
1. Per capita income: The most recent and detailed real per capita
income data was calculated and reported by Asian Development Bank
based on a detailed study of a list of around 800 household and
nonhousehold products in 2005 and early 2006 to compare real
purchasing power for ADB's trans-national income comparison
program (ICP). The ABD ICP concluded that Pakistan had the
highest per capita income at HK$ 13,528 (US $1,745) among the
largest nations in South Asia. ADB reported India’s per capita as
HK $12,090 (US $1,560). Nominal per capita GDP estimates for
Pakistan range from US $1000 to US $1022, while the range for
India is from US $ 1017 to US $ 1100.
June 6, 2011
2. According to the 2009 UN Human and Income Poverty Report, the

people living under $1.25 a day in India is 41.6 percent, about twice
as much as Pakistan's 22.6 percent. The most recent estimates by
UNDP in Pakistan for 2007-2008 indicate poverty level at 17.2%.
3. India ranks 66th on the 2008 Global Hunger Index of 88 countries

while Pakistan is slightly better at 61 and Bangladesh slightly worse
at 70.
India's literacy rate of 61% is well ahead of Pakistan's 50% rate.
One out of every three illiterate adults in the world is an Indian,

according to UNESCO. Pakistan stands fourth in the world in terms of
illiterate adult population, after India, China and Bangladesh.
Poverty:
Population living under $1.25 a day - India: 41.6% Pakistan: 22.6%

Source: UNDP
Nutrition:
Underweight Children Under Five (in percent) Pakistan 38% India

46% Source: UNICEF
Health:
Life expectancy at birth (years), 2007 India: 63.4 Pakistan: 66.2

Source: HDR2009
Education:
June 6, 2011
Youth (15–24 years) literacy rate, 2000 to 2007, male Pakistan: 80%
India 87% Source: UNICEF
Youth (15–24 years) literacy rate, 2000 to 2007, female Pakistan 60%
India 77% Source: UNICEF
Economics:
GDP per capita (US$), 2008 Pak:$1000-1022 India $1017-1100
 CHINA
Performance of the Chinese insurance market:
After Japan and South Korea, China is the third largest insurance market in Asia.
In 2004, China’s insurance market grew 10.63% to $52 billion (Figure 7.24) .
Between 2000 and 2004, China’s insurance market has experienced a period of
strong performance. Life insurance in 2004 contributed more than 67.86% of total
insurance, up from 60% in 2003.
The growth of non-life insurance was even more pronounced than life insurance in
2004, up more than 21% compared with 7% for life insurance.
Liberalization of the insurance industry and rising income levels has boosted the
insurance market in China. Life insurance products as a safer investment avenue
have been very attractive to the customers. However, due to high acquisition costs
and negative interest rate spreads in guaranteed return products, profit margins of
the insurers are decreasing.
The Chinese insurance market will become increasingly liberalized and open for
foreign participants in the next five years. Many more non-life and life companies
will be licensed to operate in China, and geographic and market restrictions will be
largely eliminated. With penetration at a meager 3.26% in 2004, that is 1.05 % for
June 6, 2011
non-life and 2.21% for life insurance products, and an economy steaming ahead at
an annual real GDP growth rate of over 9.5%, China is poised to emerge as a major
insurance market in the region.
Insurance industry in China:
The Chinese insurance industry has experienced rapid expansion over the past
decade, with annual life-insurance premiums growing from 10 billion U.S. dollars
in 1999 to 46 billion U.S. dollars in 2006.
In addition to steadily increasing demand, two major supply-side trends have

encouraged the development of the industry: (1) under the World Trade
Organization (WTO) framework, the Chinese government lowered entry barriers to
foreign insurers, allowing them to establish joint-venture insurance firms in China;
and (2) domestic insurers strengthened themselves through IPOs and other market
developments. (For example, China Life Insurance has become the second largest
insurance company in the world in terms of market capitalization.)
As of 2007, China had 100 insurance companies, 59 of which are domestic-funded

and the rest 41 are foreign-funded. And five Chinese insurance companies
including the People's Insurance Company of China, China Life Insurance, Ping
An Insurance Company of China, China Insurance International Holdings Co., Ltd.
(CIIH) and China Pacific Insurance have listed at home and abroad.
China Life Insurance had about a 50% share of the life insurance market; Ping An
Life Insurance and Ping An Property Insurance share 16% and 12% of
corresponding insurance markets, respectively ranking 2nd and 3rd.
In Jan-May 2007, the increased insurance assets reached RMB 450 billion, without
calculation the value-added of substantive financial assets. At present, the gross
assets of China Life Insurance have outnumbered RMB 1 trillion. And the total
capital of the whole insurance industry has exceeded RMB 200 billion, 5.6 times
that of 2002.
During the first three quarters of 2009 China's insurance companies had generated
profits 36.9 billion RMB of which the seven largest insurers accounted for 90% of
these profits.
June 6, 2011
China Insurance Industry Report, 2007:
At present, China has 100 insurance companies all together, 59 of which are
domestic-funded and the rest 41 are foreign-funded. And five Chinese insurance
companies including the People's Insurance Company of China, China Life
Insurance, Ping An Insurance Company of China, China Insurance International
Holdings Co., Ltd. (CIIH) and the Min An Insurance (China) Co., Ltd. have listed
at home and abroad. As the most thoroughly opened industry in China's finance
field, the insurance industry is having more and more furious competition.
The market shares of China Life Insurance and Ping An Insurance Company of
China not only keep stable, but also present a continuous rising momentum. China
Life Insurance covers about 50% of the whole life insurance market; Ping An Life
Insurance and Ping An Property Insurance share 16% and 12% of corresponding
insurance markets, respectively ranking 2nd and 3rd.
In Jan-May 2007, the increased insurance assets reached RMB 450 billion, without
calculation the value-added of substantive financial assets. At present, the gross
assets of China Life Insurance have outnumbered RMB 1 trillion. And the total
capital of the whole insurance industry has exceeded RMB 200 billion, 5.6 times
that of 2002.
 BANGLADESH
The standard of living in Bangladesh is extremely low, Bangladesh may not be

able to provide foreign nationals in the country with the services that they need. In
regards to healthcare, the treatment standards are typically very poor, and many
medical facilities will not be able to offer patients anything other than immediate
emergency care.
Feeling comfortable in the knowledge that if something was to happen to a family

member their medical costs will be taken care of, is important to us all. Our expert
June 6, 2011
consultants can advise on the most suitable level of coverage for families,
individuals, groups, travelers, and teachers expatriate health insurance.
Expatriate Health Insurance Bangladesh:
In addition to the lack of basic medical facilities throughout the country, there is a
major concern in Bangladesh regarding communicable diseases. Due to the
country's location and the prevalence of severe floods during the monsoon season,
there are yearly outbreaks of a number of major diseases, including typhoid,
dengue fever, malaria, and others. This is a serious problem and accounts for many
deaths annually. The problem of flooding has also been linked to the high infant
mortality rates throughout the country and despite the high level of fertility
throughout Bangladesh, approximately 125 infants will die per every 1000 births.
Despite any progress made, however, the provision of healthcare in the country is
still in a state that is much lower than expected. Most hospitals and clinics will not
be able to provide any care outside of emergency treatment. In addition to this
many Bangladeshi medical facilities will require a cash payment prior to treatment,
and in some cases this has been requested even where an individual has health
insurance. In serious situations patients are typically evacuated from the country to
a nearby center of medical excellence, typically to India or Thailand. These
evacuations can be expensive, and without adequate insurance coverage can place
a burden on an individual's financial situation.
Due to the inadequate nature of the country's healthcare services it is advised that
any foreign nationals in the country ensure that they take measures to prevent
sickness and disease. Avoid swimming in public waterways and the ocean, as these
may be contaminated by human waste. Always ensure that you are drinking water
from a clean source. This comes in addition to carrying some form of anti-diarrhea
medication at all times. In the event that you suffer from diarrhea for more than 72
hours, you should consult a medical authority.
Many developing countries, including Bangladesh, are affected by a “Double

Burden” of disease and scare of resources (WHO 95).
June 6, 2011
In Bangladesh about 64% of the health expenditure come from the “out of pocket
of the house hold” 33% is provided by the government sector and the remaining
comes from the NGOs services.
A comparison between Bangladesh and china

health care system
Bangladesh Life expectancy at birth:
Life expectancy at birth: total population: 69.75 years

male: 67.93 years
female: 71.65 years (2011 est.)
Year Life expectancy at birth Rank Percent Change Date of Information

2003 61.33 169 2003 est.
2004 62.08 169 1.22 % 2004 est.
2005 62.08 169 0.00 % 2005 est.
June 6, 2011
2006 62.46 169 0.61 % 2006 est.

2007 62.84 166 0.61 % 2007 est.
2008 63.21 167 0.59 % 2008 est.
2009 60.25 181 -4.68 % 2009 est.
2010 69.44 148 15.25 % 2010 est.
2011 69.75 148 0.45 % 2011 est.
China Life expectancy at birth:
Life expectancy at birth: total population: 74.68 years

male: 72.68 years
female: 76.94 years (2011 est.)
Year Life expectancy at birth Rank Percent Change Date of Information

2003 72.22 95 2003 est.
2004 72.27 104 0.07 % 2004 est.
2005 72.27 106 0.00 % 2005 est.
2006 72.58 106 0.43 % 2006 est.
2007 72.88 102 0.41 % 2007 est.
2008 73.18 103 0.41 % 2008 est.
2009 73.47 104 0.40 % 2009 est.
2010 74.51 93 1.42 % 2010 est.
2011 74.68 95 0.23 % 2011 est.
June 6, 2011
Definition: This entry contains the average number of years to be lived by a group
of people born in the same year, if mortality at each age remains constant in the
future. The entry includes total population as well as the male and female
components. Life expectancy at birth is also a measure of overall quality of life in
a country and summarizes the mortality at all ages. It can also be thought of as
indicating the potential return on investment in human capital and is necessary for
the calculation of various actuarial measures.
Bangladesh Infant mortality rate:

female: 48.13 deaths/1,000 live births (2011 est.)
Year Infant mortality rate Rank Percent Change Date of Information

2003 66.08 52 2003 est.
2004 62.6 49 -5.27 % 2004 est.
2005 62.6 46 0.00 % 2005 est.
2006 60.83 47 -2.83 % 2006 est.
2007 59.12 44 -2.81 % 2007 est.
2008 57.45 43 -2.82 % 2008 est.
2009 59.02 39 2.73 % 2009 est.
2010 52.54 48 -10.98 % 2010 est.
2011 50.73 47 -3.44 % 2011 est.
June 6, 2011
China Infant mortality rate:

female: 16.57 deaths/1,000 live births (2011 est.)
Year Infant mortality rate Rank Percent Change Date of Information

2003 25.26 105 2003 est.
2004 24.18 101 -4.28 % 2004 est.
2005 24.18 101 0.00 % 2005 est.
2006 23.12 102 -4.38 % 2006 est.
2007 22.12 102 -4.33 % 2007 est.
2008 21.16 105 -4.34 % 2008 est.
2009 20.25 104 -4.30 % 2009 est.
2010 16.51 113 -18.47 % 2010 est.
2011 16.06 112 -2.73 % 2011 est.
Definition: This entry gives the number of deaths of infants under one year old in
a given year per 1,000 live births in the same year; included is the total death rate,
and deaths by sex, male and female. This rate is often used as an indicator of the
level of health in a country.
June 6, 2011
China: Physicians
Description:
Number of physicians per 1,000 people. Physicians are defined as graduates of any
facility or school of medicine who are working in the country in any medical field
(practice, teaching, research). World Bank (WHO).
Year: 1970 1980 1990 2000 2002
Physicians
(Number of physicians per 1,000 people): 0.86 1.18 1.55 1.64 1.642473
Bangladesh: Physicians
Year: 1970 1980 1990
Physicians (Number of physicians per 1,000 people) 0.1187 0.1205 0.1767

June 6, 2011
Proportion of GDP spent on health care :
China:
With its massive 1.3 billion populations, China's health care expenditures are
miniscule compared to Western nations. China spent less than 5 percent of its GDP
on health care in 2005.
Bangladesh:
Total health care expenditure as percentage of GDP is 3.10.public share of total

health expenditure as percentage of GDP is .87.private share of total health
expenditure as percentage of GDP is 2.23.
Public health-care in China:
China is undertaking reform of its health-care system. The New Rural Co-
operative Medical Care System (NRCMCS) is a 2005 initiative to overhaul the
healthcare system, particularly intended to make it more affordable for the rural
poor. Under the NRCMCS, the annual cost of medical coverage is 50 Yuan (US$7)
per person. Of that, 20 Yuan is paid in by the central government, 20 Yuan by the
provincial government and a contribution of 10 Yuan is made by the patient. As of
September 2007, around 80% of the rural population of China had signed up
(about 685 million people). The system is tiered, depending on the location. If
patients go to a small hospital or clinic in their local town, the system will cover
June 6, 2011
roughly 70-80% of their bill . If the patient visits a county clinic, the percentage of
the cost being covered falls to about 60% . If the patient requires a specialist in a
modern city hospital, the plan would cover about 30% of the bill.
Public health-care in Bangladesh:

Bangladesh has made significant progress in recent times in many of its social
development indicators particularly in health. This country has made important
gains in providing primary health care since the Alma Ata Declaration in 1978. All
health indicators show steady gains and the health status of the population has
improved. Infant, maternal and under-five mortality rates have all decreased over
the last decades, with a marked increase in life expectancy at birth. It has achieved
a credible record of sustaining 90% plus vaccine coverage in routine EPI along
with NIDs (national immunizations days) since 1995. But some of this progress is
uneven and there still exists inequalities between different groups and geographical
regions. A major constraint identified towards reaching the MDGs and other
national health goals is the issue of shortages in the health workforce and the
uneven skill mix.
Like most transitional societies, a wide range of therapeutic choices are available
in Bangladesh, ranging from self care to traditional and western medicine. The
public sector is largely used for in-patient and preventive care while the private
sector is used mainly for outpatient curative care. Primary Health Care (PHC) has
been chosen by the Government of Bangladesh as the strategy to achieve the goals
of “Health for all” which is now being implemented as Revitalized Primary Health
Care.
June 6, 2011
June 6, 2011
Recommandations
Pakistan is the 6th largest state of the world having a huge flux of population living
in rural and urban areas. The Federal Government of Pakistan after taking her due
share from NFC award promise to fulfill the four major objectives i.e security,
education, health and sanitation. Unfortunately, only 1.5% of entire budget is
allocated to health and sanitation which is insufficient. (So sufficient budget should
be located to health sector to counter this problem.)
Secondly, the sanitary conditions are deplorable and the stagnant water absorbs
150 feet in the soil mixing up with clean water, which is spreading severe diseases.
Owing to this poor sanitary condition W.H.O projected the idea of oral polio
vaccination. (Steps should be taken to improve sanitataion conditions.)
Additionally, the number of doctors is less to tackle the problems of health. In

Punjab only 1400 doctors qualify every year where as statistics show that every
year 70, 000 babies born in Punjab.(Steps should be taken to remove such
discrepancies.)
The infrastructure is undeveloped. The basic health units in rural areas are not
equipped enough to better the falling health of rural populace. If there are well
equipped hospitals, the availability of doctors is not ensured. Glaringly, the quacks
are performing in every nook and corner of the country without any fear of
accountability. The medicine companies are indulging in minting money with the
help of dishonest doctor, consequently killing many people. Less attention is given
to sterilize the tools and transfer of blood without disease. Because of the religious
myths and cultural barriers less attention is given to female health which results in
the increment of MMR and TMR.(There must be strong check and balance as far
as doctors and nurses are concerned. For females, awareness should be created
through media and female health workers.)
June 6, 2011
Focusing on the golden rule of “Health is wealth”, the government of Pakistan

should take appropriate measures for the betterment of health facilities in Pakistan.
There should be strong policies with accurate implementation. The awareness
programmes should be managed to let the people know about the problems and
remedies. Their should be a strong determination for cleaning the surroundings of
the rural as well as urban populace. From domestic to international level, a
healthy society can fight against the evils of society and let the people free from
the clothes of ignorance.
June 6, 2011
June 6, 2011
Conclusion
The insurance awareness levels in Pakistan have been very low, in general. Health
insurance is an even newer concept.The overall penetration of health insurance in
Pakistan is merely around 0.5% of the total population which is very low. This
seems particularly low if one takes into account the poor general level of
healthcare facilities available to the population and the absence of any meaningful
government funded health insurance programs.
It is true that health insurance has relatively lower profit margins compared to
many other forms of insurance. In Pakistan, however, Health Insurance industry
faces additional challenges in the form of lack of credible data on health
expenditure, lack of effective record keeping of patients’ medical histories,
inadequate regulatory framework for medical service providers and a general lack
of awareness about health insurance schemes’ dynamics.
The problem is exacerbated when the industry gives way to regressive practices
like unreasonable price wars which in the long run affect the growth of the industry
adversely.
However, companies with better knowledge of market dynamics, better risk

management capabilities and prudent business practices should be able to manage
this very potent line of business profitably
June 6, 2011
Bibliography
 http://www.indexmundi.com/pakistan/infant_mortality_rate.html
 http://www.trueknowledge.com/q/how_long_do_people_live_in_pakistan
 http://library.thinkquest.org/03oct/00570/Stats/Doctorsby1000.htm
 http://www.jpma.org.pk/full_article_text.php?article_id=2143
 http://www.pide.org.pk/pdf/Working%20Paper/WorkingPaper-32.pdf
 http://gis.emro.who.int/HealthSystemObservatory/PDF/Pakistan/Exec
%20summary.pdf
 http://gis.emro.who.int/HealthSystemObservatory/PDF/Pakistan/Health
%20system%20organization.pdf
 http://www.adb.org/Documents/TARs/PAK/tar-pak-37359.pdf
 http://www.planningcommission.gov.pk/mtdf/7-Health/7-Health.pdf
 http://en.wikipedia.org/wiki/Standard_of_living_in_India
 http://docs.google.com/viewer?
a=v&q=cache:0r_0ZnTD0OsJ:www.grailresearch.com/pdf/ContenPodsPdf/
Opportunities_in_the_China_Healthcare_Sector.pdf+health+insurance+mar
ket+in+china&hl=en&gl=pk&pid=bl&srcid=ADGEESjS1l51uiwBDbgCM
Vsj8lUdwDFr93aRH7I8FB-Ad8ho0_68NFHPKaUr8okqieVkUoj-
cwaZPRSrcF17YdHor0bm-mMQpSAPwafc93gNyaht0Ep0IKIS4gDUY-
e77ZqYgyEfiu_9&sig=AHIEtbR0AENVlef7iMk1WKWl1RLXckOnWQ&p
li=1

Problems of Health Insurance Market in Pakistan

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Problems of Health Insurance Market in Pakistan

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Presented to: Mr.

“We bow our heads in gratitude to almighty Allah, Who blessed

Sr. No Topic Page

1 Preface and Acknowledgement 2-3

2 Introduction to Health Insurance 5

3 Health Insurance in Pakistan 9

4 Problems of Health Insurance Market in 23

Health insurance is insurance against the risk of incurring medical expenses. By

Before the development of medical expense insurance, patients were expected to

A health insurance policy is a contract between an insurance company and an

 Premium: The amount the policy-holder or his sponsor (e.g. an employer)

 Capitation: An amount paid by an insurer to a health care provider, for

Pakistan which is officially called the Islamic Republic of Pakistan is located in

Status of health insurance industry in Pakistan

In Pakistan, health insurance business has historically been conducted as a non-

The overall penetration of health insurance in Pakistan is merely around 0.5% of

As medical consumerism grows, the prevention & wellness should already be a

consciousness. Secondly, medical advancement would introduce newer diagnostic

Private health insurance schemes provide a straight-forward vehicle of managing

Pakistan, a developing country, had an estimated GDP of $449.3 billion in 2009.

Other long-term challenges include expanding investment in education, healthcare,

 Public Health Care System

of the National Economic Council (ECNEC), the Economic Coordination

Levels of Health Care:

Primary Health Care Centers:

Referral Level Care Facilities:

District Headquarters Hospitals (DHQH) serve a catchment population of about 1

Tertiary Care Facilities:

 Pakistan Health Insurance System

Although Pakistan Health Insurance system is not as much developed; Government

Health Policy of the Government Vision:

2. Develop and manage competent and committed health care providers

3. Generate reliable health information to manage and evaluate health services

4. Adopt appropriate health technology to deliver quality services

5. Finance the costs of providing basic health care to all Pakistanis

6. Reform the health administration to make it accountable to the public

 Private Health Care System

Problems of Heath Insurance Market

i. improving governance in public sector institutions,

4. Total expenditure on social protection represents around 2% of GDP, of which

8. The health care financing system consists of three alternative protection

i. frequent unofficial charges,

The comparison is done between four Asian countries to show the

The World Health

Total Expenditure on Health as % of GDP 2000-2005

India 4.3 4.6 4.8 4.8 4.9 5

Infant mortality rate: total: 63.26 deaths/1,000 live births

The average age in pakistan is 65.5 years

Malnutrition is big problem in Pakistan. Human Conditions Report (2003) clearly

Doctors (2009) 139,555

Dentists (2009) 9,822

Nurses (2009) 69,313

Midwives (2009) 26,225

Health visitors (2009) 10,731

Registered vets (2009) 4,800

care is supposed to be free, problems encountered are (i) frequent unofficial

Health Insurance and Employees Social Security Third–Party health insurance is

According to the Economic Survey of Pakistan (2007 - 2008), the government

Future of Indian insurance market:

Liberalization of the insurance market, increasing competition, the introduction of

2. According to the 2009 UN Human and Income Poverty Report, the

3. India ranks 66th on the 2008 Global Hunger Index of 88 countries

India's literacy rate of 61% is well ahead of Pakistan's 50% rate.

One out of every three illiterate adults in the world is an Indian,