Consulting Services, Utilization Study for Health Insurance Initiative

Project Measures:

KfW has been supporting social health protection for the poor in Khyber Pakhtunkhwa (KP) and Gilgit Baltistan (GB) since 2014. Under the Phase 1 of the Support to Social Health Protection Initiative (SHPI Phase I, BMZ no. 2009 66 168, the “Project”) implemented since 2016, KfW finances a social health protection program in selected districts of KP and GB with the aim of increasing access of the poor to quality health services, removal of financial access barriers and strengthening the demand side. The health insurance scheme under Phase 1 focuses on the poorest 21% of the population and covers inpatient (IPD) health services only. A total of approx. 100,000 households with a total of approx. 800,000 people in selected districts in KP and GB have been enrolled under the health insurance initiative since its launch. SHPI Phase I is still being implemented and expected to be completed in 2021. However, an extension of phase 1 may still be considered. Utilization rates for the IPD coverage under SHPI Phase I remain lower than anticipated. At the time of planning, a minimum utilization of 3% was estimated. This estimation was however not based on actual actuarial calculations due to the absence of historical data. Since its initiation, the service coverage under the IPD scheme has been expanded. However, instead of an inspected increase in utilization, the rates have further declined. 

Brief description of the Contract:

• The Services solicited are for a study to review and analyse the hospitalization and utilization rates of the IPD scheme supported under the Project. The Consultant shall analyse which and hospitalization and utilization rate should be expected in the Project’s target group. For this, the Consultant shall collect data on hospitalization and utilization rates of similar insurance schemes in the region and globally for countries with comparable socio-economic contexts. If it turns out that hospitalization and utilization should be higher than actual utilization rate, the Consultant shall in a second phase assess the reasons for this outcome. This analysis shall be substantiated by adequate quantitative and qualitative data compiled by the Consultant including field data collection in the target provinces through targeted surveys. The study shall produce a report with clear proposals to adjust the insurance scheme policy to improve the outcomes.