PESHAWAR: The Khyber Pakhtunkhwa government has decided to adopt fund management model for free treatment of people under Sehat Card Plus scheme to save money, according to officials.
Currently, the programme operates under insurance model under which the government pays Rs4,000 premium per family to State Life Insurance Corporation (SLIC), the implementer of the scheme on annual basis. In line with fund management model, the government will pay actual cost of patients’ treatment in addition to5.6 per cent (Rs1.8 billion) as administrative cost to the firm.
Officials said that the model approved by the cabinet in its last meeting held on November 14 would stand implemented from July 1, 2025 as currently the programme was being run by SLIC under one-year temporary arrangement as the last five-year agreement expired on June 30, 2025.
They said that under the new model of fund management, the government would be able to save Rs7 to Rs8 billion annually.
The model, approved by cabinet, will stand enforced from July 1, 2025
Minutes of the cabinet’s meeting are still awaited but officials told this scribe that there would be two types of payment to SLIC at the end of every month. One is the actual cost of patients’ treatment, which will be around Rs35 billion and another payment will be administrative expenses in lieu of the services including contract with empanelled hospitals, gate-keeping, monitoring and claim management.
“The agreement, yet to be signed with SLIC, will bring down the yearly cost of SCP from an estimated Rs45 billion to Rs37 billion,” officials said.
They said that at the end of year, SLIC would return the unspent amount. SCP, started in 2016 from four districts with coverage of poor people, has been extended to the entire population of the province (10.6 million families) in a phased manner.
Officials in health department said that a permanent and sustainable implementation model was required for the future of the programme. The policy board of SCP after extensive deliberations on the matter had agreed upon two implementable options, for which a summary was submitted to cabinet with two options, they said. One of the options was a fund management model and the other was an insurance model, they added.
According to the summary, the fund management model was more acceptable and adaptable in terms of finances while the insurance model was more expensive and less adaptable due to which the cabinet accorded approval to the former as the future design for the programme.
In fund management model, the government allocates funds periodically to a fund manager, who reimburses hospitals for services provided under the agreed package. “This model offers greater financial flexibility and high coverage with minimal out-of-pocket expenses but poses challenges in gate-keeping,” said officials.
In insurance model, the government pays a fixed annual premium per family to an insurance company. It provides predictable costs, and better gate-keeping but it is relatively more expensive and less flexible during the contract period.
For managing funds, the fund manager charges administrative expenses.
Officials said that SLIC would act as fund manger under the new model but it would save money to the government. The insurance firm has been implementing the programme since its onset in Khyber Pakhtunkhwa. It is getting administrative expenses but after enforcement of the new model, it will get only the actual cost of patients’ treatment along with administrative expenses.
The programme has benefitted about five million patients at a cost of Rs125 billion so far. Currently, there are 166 empanelled hospitals in Khyber Pakhtunkhwa and the total number of empanelled hospitals throughout the country is 700.
Published in media, November 18th, 2025
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