بسم اللہ الرحمن الرحیم
Education and Health had been the primary responsibilities of every Government. For these responsibilities, Governments gets money from treasury and philanthropic sources. In the Golden Era of Islam from 7th to 15th Centuries, Healthcare was provided totally free to the public as Muslim Governments were extremely rich, very moral, and selfless. The hospitals in Islamic lands were financed from the revenues of endowments. Wealthy men & women, and especially rulers, donated property as endowments, whose revenue went toward building and maintaining the institutions.
Great rulers like Salahuddin Ayyubi, Mamoon Rashid and Mehmood Ghaznawi spent almost all their wealth on education, research, and public welfare.1. Even when Governments were not that rich, still public hospitals were providing commendable free or very low-cost services to the public. Because of overall moral disintegration of the society, these hospitals were inflicted by massive corruption in the administration, healthcare workers and in many doctors. Despite all these there were relatively good services for the poor patients. There was no need to buy any insurance neither by the patients nor by the Governments.
With time however, public sector education and healthcare were gradually weaned off partly due to the corruption in the society and partly because of much less funding of the Governments in these areas. Simultaneously various private educational and healthcare institutes erupted which attracted middle and upper class but were of no or minimal use to the poor except a few.
In wealthy countries like USA Governments pumped a lot of money into the health system to take care of its citizens and legal aliens. However, this resulted in very high medicine prices and medical care. The whole system including doctors and hospitals became almost servants to the insurance system. Liability insurance and frequent suing of doctors and hospitals increased the health cost and led to too many unnecessary tests to save one’s skin. This put lot of burden on the Governments which in turn borrowed a lot of money on compound interest that resulted in very high inflation and wealth being accumulated in a few hands and families which also promoted wars to make more money but also inflicting severe injuries to the economy of the nations and physical and mental injuries to the patients!
In third world countries like Pakistan, then came “Health Cards” which were based on a kind of insurance. These benefitted insurance companies and some blue-eyed hospitals but did little good to the patients. Let me quote following from an article on Health Card to emphasize my point. “The issuance of cards will continue to make the plan a reality for political gains. There will come a time when the government will give-up the claim of health cards being free, and the people will have two options to pay the premium themselves or go to the private sector for treatment. This will not only deprive the poor of access to public hospital facilities but will also create a monopoly on the private sector and increase the cost of medical treatment. This could also be a nightmare for doctors who are receiving jobs in government hospitals today and yet appear to be protesting daily for benefits and pay raises. Given the closure of public hospitals, the private sector will be performing tedious duties in long shifts at extremely low salaries.
This insurance system will open new avenues for corruption and opening private hospitals will be become a lucrative business receiving fake insurance. It will also be a new formed of political bribery through which the government will reward its favorite hospitals and their owners. The government will use budget, mismanagement, or corruption as an excuse to get rid of public hospitals and make the lives of the public even more miserable.”2
Another article concluded, “The results show that health insurance is associated with higher use of the physician services but does not promote the use of cost-effective schedules of care among the publicly insured.” 3
A research group has suggested that “a fundamental change in the health care system to move toward a primary care-based system is essential to achieve improvements in access, quality, and cost.” 4
In conclusion, to improve the healthcare in countries like Pakistan, very first step should be to improve the overall ethics and morality of the society that will in turn produce better students, competent teachers, honest scientists, and excellent upright doctors. Public health and educational institutions must be strengthened. Corruption need to be rooted out through just and efficient judiciary and frequent reminding of the public about Quranic and Prophetic (PBUH) teachings and shunning useless and destructive activities and attitudes. The so-called Health Cards are mere gimmicks overburdening exchequer. Premium paid to the insurance companies should be directed channeled toward health budget. Without intermediaries who suck up most of the budget, funding to the patient care should be direct through honest hands with strict accountability and strong feedback system!