Understanding Facilitation Practices Across the Patient Care Continuum in Pakistan’s Social Health Insurance Scheme

Abstract

Social Health Insurance (SHI) is a key social protection instrument that helps to achieve equity in access to health services and to advance Universal Health Coverage (UHC). Financing arrangements are only part of the solution for effective implementation of SHI; facilitation practices are also important in ensuring that healthcare providers are able to provide timely and accessible services to beneficiaries. The present research focuses on the facilitation practices of public and private healthcare providers for the implementation of a big social health insurance in Lahore, Pakistan with special reference to its role in enhancing healthcare access and service delivery. The following qualitative research design was adopted and a total of 15 semi-structured interviews were conducted with administrators and relevant staff from nine public and private healthcare providers, insurance agency and health ministry Lahore. All interviews were transcribed word for word and analyzed using thematic analysis. The four themes were: (1) Entry-point facilitation – provider participation was influenced by social responsibility, patient demand, awareness initiatives and expectations of program expansion; (2) Service facilitation – differences in administrative processes between the public and private providers affected their capacity to deliver service timely; (3) Documentation and coordination facilitation – many stakeholders were involved in documenting and coordinating services, with some stakeholders more involved than others in the decision making process; and (4) Financial facilitation barriers – delayed reimbursements, inadequate service rates, and limited provider participation in the decision making process affected providers capacity to sustain equitable healthcare services. The results highlight the importance of facilitation practices as a key part of social protection and health service provision. From the social work and social policy point of view, formal coordination systems, more active involvement of providers, better communication and electronic claim management systems with clear rules can be introduced to ensure equitable access to health services, improve the quality of services and increase the effectiveness of the Pakistan's Social Health Insurance program.