Pakistan Bureau of Statistics National Health Accounts 29
from a secondary source (see Section 2.5.3). As a cross-checking mechanism, the expenditures from the supply side were compared with out-of-pocket expenditures on health (demand side). Some less significant providers of health services are not covered. This is mainly true for other retailers of medical goods, e.g., opticians and chemists, and for providers of ambulatory services carried out as secondary activity, only (e.g., taxi drivers). It is envisaged to extend the scope of the health care providers dimension in the forthcoming rounds of Health Accounts. 2.5.2 Private health care providers expenditures: Extrapolation from 2009-10 to 2021- 22. The expenditures of Outpatient service providers and Laboratories & Diagnostic Service Providers have been extrapolated on the basis of Consumer Price Index (CPI) computed for a group of health-related commodities such as Doctor’s fee, Laboratory tests and different medi- cines etc. categorized as” Health Group” in the Consumer Price Index. the inflation rate recorded for health-related commodities categorized as “Health Group", in the CPI of 2021-22 on the basis of 2019-20 (almost 17%). 2.5.3 Health care providers: Overview of results The following tables (21 & 22) give an overview of expenditures of private health care providers by type and by kind of ownership for the year 2021-22. The expenditures for the year 2021-22 have been estimated on the basis of data obtained from the survey/Census of all private health care providers conducted for the year 2009-10. Table 21: Expenditures of private health care providers 2021-22 Description Hospitals Out-Patient Service Providers Laboratory & Diag- nostic Service Pro- viders Total Million Rs. Pakistan 97,474 196,696 18,549 312,719 Punjab 37,545 102,246 11,574 151,365 Sindh 51,042 33,906 4,809 89,757 KP 8,416 54,303 1,963 64,682 Baluchistan 471 6,241 203 6,915 In % Pakistan 31 63 6 100.00 Punjab 25 67 8 100.00 Sindh 57 38 5 100.00 KP 13 84 3 100.00 Baluchistan 7 90 3 100.00 Table 21 shows the estimated expenditures of private health care providers and its per- centage break-up by major type of service. The estimated total expenditure incurred by all types of health care providers at national level was Rs.313 billion in share in total expenditure from
Pakistan Bureau of Statistics National Health Accounts 30
health care providers is bumpy among the provinces. Punjab has the highest share of 48% while Baluchistan has the smallest share of 2% of the total expenditure. Sindh and KP have a share of 29% and 21% respectively. With regard to health care providers the category ‘Out-Patient Service Provider’ has the highest share in expenditure (62.9%) followed by ‘Hospitals’ (31.17%) and ‘Laboratory & Diag- nostic Service Providers’ (5.93%) at national level. Table 21 also indicates that Baluchistan and KP have the highest share in expenditure with reference to out-patient service providers as compared to Punjab and Sindh. In categories of Hospitals and Laboratory & diagnostic service providers, Punjab and Sindh have higher proportion than KP and Baluchistan. Table 22: Expenditures of Private Hospitals by kind of Ownership 2021-22 Description NGO / NPO Individual Pro- prietorship Private Limited Company Partner- ship Trust Others Total Million Rs. Pakistan 5,572 22,958 42,680 3,178 17,434 5,652 97,474 Punjab 2,087 13,136 12,630 1,479 7,728 486 37,546 Sindh 3,019 6,247 26,305 751 9,554 5,166 51,042 KP 418 3,313 3,745 787 152 0 8,415 Baluchistan 48 262 0 161 0 0 471 In % Pakistan 05.71 23.55 43.79 03.26 17.88 05.80 100.00 Punjab 05.56 34.99 33.64 03.94 20.58 01.29 100.00 Sindh 05.91 12.24 51.54 01.47 18.72 10.12 100.00 KP 04.96 39.37 44.50 09.36 01.81 00.00 100.00 Baluchistan 10.17 55.58 00.00 34.24 00.00 00.00 100.00 Table 22 shows the estimated expenditure and percentages of private hospitals by the kind of its ownership respectively. The highest expenditure is incurred by “Private limited com- pany” (Rs. 42,680 million, 44%) followed by “individual proprietorship” (Rs. 22,958 million, 24%). The total expenditure of Sindh (Rs. 51,042 million, 52%) is more than Punjab (Rs. 37,546 million, 39%) apparently because metropolis Karachi, located in Sindh, is the hub of health facilities in Pakistan. The expenditure of hospitals run by “Trusts” was Rs. 17,434 million (18%). The hos- pitals run by “Partnerships” and “NGO/NPO” incur only 3.26% and 5.71% of the expenditures. The expenditure of hospitals categorized as “Private limited company” is higher than all other ownership categories. Sindh and KP have the highest expenditures in “Private limited company” while Baluchistan & Punjab have the highest expenditures in “individual proprietorship”. Table 23 gives an overview of the current health expenditure for the fiscal year 2021-22 by all those providers which were covered in the survey/census of private health care providers 2010-11 and other administrative data (General Govt. Data). The classification applied for this is given in detail in Annexure 8. HP.1 shows Hospitals and HP 1.1 denotes the General Hospitals which are further disaggregated into government-owned general hospitals, Hospitals under so- cial security, Hospitals of AB/Cs under the federal/provincial governments, etc. HP 1.2 shows
Pakistan Bureau of Statistics National Health Accounts 31
the category of mental health and substance abuse hospitals which are further disaggregated
into three sub-categories. HP 1.3 shows other specialty Hospital (hospitals only for a specific
disease or condition other than mental and substance abuse) which is further disaggregated
into four sub-categories. HP.3 denotes providers of ambulatory health care. HP.4 shows the
retail sale and other providers of medical goods. HP.5 denotes the provision and administration
of public health programs, HP.6 General Health administration and insurance and HP.nsk Pro-
viders not specified by kind. It mainly includes reimbursements for Sehat Sahulat Programme
figures of the federal and respective provincial governments, health expenditure of private in-
surance companies, local NGO’s, etc.
Table 23: Current health expenditures by healthcare providers 2021-22
Providers classified by relevant categories of HP- Classification
million Rs.
HP.1
Hospitals
787,085
HP.1.1
General Hospitals
770,786
HP.1.1.1
Government-owned General Hospitals
669,273
HP.1.1.2
Hospitals under Social Security
10,792
HP 1.1.3
Hospital of autonomous bodies/corporations
7,134
HP 1.1.4
Private Hospitals (Private For-Profit entities)
68,419
HP 1.1.5
Hospitals Owned by Charitable Institutions/NGOs
15,168
HP.1.2
Mental health and substance abuse hospitals
2
HP.1.3
Other specialty Hospitals
16,297
HP.3
Providers of ambulatory health care
400,134
HP.3.1
Offices of Physicians
19,786
HP.3.2
Dental clinics
7,902
HP.3.3
Offices of other Health Practitioners
135,096
HP.3.4
Outpatient care centers
191,358
HP.3.5
Medical and diagnostic laboratories
18,513
HP.3.9
Other Providers of Ambulatory care
27,522
HP.4
providers of medical goods Retail sale and other
438,323
HP.5
Provision and administration of public health Programmes
HP.6
General health administration and insurance
124,932
HP.9
Rest of the world
8,099
HP.nsk
Providers not specified by kind
176,870
Total of Providers
1,935,443
Pakistan Bureau of Statistics National Health Accounts 32
2.5.4 Retailers of pharmaceuticals
Data on sales/purchases of pharmaceuticals was provided by Inter-continental Market-
ing Services ( IMS)9 in March 2010. IMS claims to be the world’s leading provider of market
intelligence to the pharmaceutical and healthcare industries. Their data set of sales of pharma-
ceuticals is divided into fifteen broad functional categories as represented in the table below
covering the period from October 2008 to September 2009 . Data for the complete fiscal year
was given for the totals of pharmaceutical sales, only. Therefore, the percentage share for each
functional category for October 2008 to September 2009 was applied to the total pharmaceutical
sales of FY 2007-08. Other years are in Annexure 11.
The percentage share for the retail of pharmaceuticals, ‘doctors’ purchase, and private
hospital pharmacies’ purchase was calculated from the figures available for Oct 2008 to Sep
2009. This percentage share was then applied to the total pharmaceutical sales of the fiscal
year.
9http://www.imshealth.com/portal/site/imshealth Pakistan Bureau of Statistics National Health Accounts 33
Table 24: Purchases of pharmaceuticals in Pakistan 2021-22 (million Rs.)
Total Sales
Purchases
through retail
Doctor's
Purchases
Private Hospi-
tal Pharmacies
Total Industry
488,077
438,323
30,698
19,056
A - Alimentary T.& Metabolism
104,530
95,803
5,126
3,601
B - Blood + B. Forming Organs
15,024
13,367
921
736
C - Cardiovascular System
34,526
32,788
862
875
D - Dermatological
16,765
15,446
917
401
G - G.U. System & Sex Hormones
14,939
13,433
849
656
H - Systemic Hormones
5,044
4,365
413
266
J - Systemic Anti-Infectives
129,779
110,978
12,255
6,546
K - Hospital Solutions
2,633
2,349
113
170
L- Antineoplastic + Immunomodulant
11,638
9,331
1,376
931
M - Musculo-Skeletal System
34,528
31,452
1,781
1,295
N - Nervous System
47,279
43,501
2,244
1,534
P - Parasitological
15,015
13,827
873
315
R - Respiratory System
37,084
34,846
1,397
841
S - Sensory Organs
9,527
7,726
1,296
505
T - Diagnostic Agents
288
160
36
91
V - Various
9,481
8,951
239
291
The total of the purchases through retailers (Rs.438 billion) is the one entering in the tables of provision of health care goods and services. The other sales (doctors and pharmacies of hospitals) are part of the expenditures already captured through the surveys of the providers. Thus, there is no double-counting. 2.6 Health care providers by financing agents Matrix 2 shows the flow of funds for health expenditures in Pakistan channeled by fi- nancing agents (in columns) to the providers of health care (in rows). Reading example: in case of federal government, Ministry of Health, Ministry of Population Welfare, Ministry of Defense through military setup and other ministries are financing agents while hospitals or other health care facilities under the federal/provincial/district governments are the health care providers. The allocation to providers has been done as far as empirically possible. However, some amount falls under row “HP.nsk”. For some agents (Reimbursements, Sehat Sahulat Programme, In- surance, local NGOs etc.) spending for health is available as “HP.nsk”, only.
Pakistan Bureau of Statistics National Health Accounts 34
The provider figures are not fully comprehensive as retailers for other health goods than pharmaceuticals are missing (opticians, retailers of hearing aids, artificial limbs, orthopedics etc.). But in full-fledged recording of providers even taxi drivers as well as florists, bakeries or canteens (row “all other industries”) may be accounted for as the payments for transports, gifts etc. are included in the health expenditures reported by the private households under OOP.
Pakistan Bureau of Statistics National Health Accounts 35
Matrix 2: Current Health Expenditures by Health Care Providers and Financing Agents 2021-22 (Million Rs.)
Health Care Providers
Financing Agents
HF.1 General Government
HF.2 Private Sector
HF.3.1
Official
donor
agen-
cies
Total
HF.1.1 Territorial Government
HF.1.2 Social Se-
curity Funds
HF.1.3
Auton-
omous
Bodies
HF.2.2
Other
private
insur-
ance
HF.2.3
Private
house-
holds'
OOP
HF.2.4
NGOs
Fed. Government
Provinces
District
bodies
ESSI
Zakat &
Baitul
Mal
Civil
Mili-
tary
HP.1
Hospi-
tals
HP.1.1
Gen-
eral
Hospi-
tals
HP.1.1.1
Gov. owned general hosp.
124,287
49,281
313,140
86,064
2,848
157,289
669,273
HP.1.1.2
Hosp. under Soc. Security
12,415
10,792 HP.1.1.3 Hospital of autonomous. Bod- ies
7,134
7,134 HP.1.1.4 Private Hospitals
68,419
68,419 HP.1.1.5 owned by Charity / NGOs
15,168
15,168 HP.1.2 Mental Health & Substance Abuse H.
2
2 HP.1.3 Other Specialist hospitals 1,052 417 2,651 729 105
11,342
16,297 HP.3 Pro- vider of Am- bula- tory Health Care HP.3.1 Offices of Physicians
19,786
19,786 HP.3.2 Dental Clinics
7,902
7,902 HP.3.3 Offices of other health Practitioners
135,096
135,096
Outpatient Care Centers
HP. 3.4.1 Public
24,984
9,906
62,946
17,300
2,496
2,414
185,304 HP. 3.4.2 Private
6,011
6,011 HP.3.5 Medical & Diagnostic Labs
18,513
18,513 HP.3.9 Other providers of ambulatory care
27,522
27,522 HP.4 Retail sales & other providers of medical goods
438,323
438,323 HP.5 Provision & admin. of public health programs HP.5.1 Fam. Planning & Prim. H. Care
HP.5.2 Immunization (EPI), Diarrheal Dis.
HP.5.3 to HP.5.10 Other Programs
HP.6 General Health admin & Insurance 2,706
85,092 28,033
9,101
124,932 HP.9 Rest of the world
8,099 8,099 HP.nsk 6,393 956 40,522 419 67
12,473 7,159 8,940 99,941
176,870 Total Current health expenditures 159,422 60,560 504,351 132,545 15,083 2,848 19,607 16,260 916,727 99,941 8,099 1,935,443