Economics of health and health care in Pakistan.

814 The role of health economics is well-recognised for efficient and equitable health system. 1 In developing countries though health system challenges are slightly different from developed countries, health economics tools are equally applicable. 2 Pakistan is a low-middle income developing country. The health system of the country has evolved to a well-planned district based network of health facilities with highly-skilled manpower and availability of lifesaving medicines with indigenous manufacturing capacity. Meanwhile, the expectations from the health system have also increased over the last few years. The present health system is facing difficulty in coping with growing pressure from the media, politicians and the civil society. Every other day electronic and print media covers negligence in medical practice, strikes by medical staff, harmful effects of spurious and low quality medicine, unethical medical practice, out of order diagnostics equipment in government hospital, spread of epidemics and last but not the least presenting patients and families entrapped into poverty due to catastrophic out-of-pocket health expenditure. Implicit in these stories are the weaknesses of the health care system in providing services according to the needs of the population. None of the key stakeholders i.e. government, health care providers and the patients are better off with the existing framework of policy, financing, regulation and delivery of health care in the country. Some key issues of the health system of Pakistan are summarised below. The health policy and planning focus is diseases rather than health. There are huge investments on programmes and intervention to eliminate or control diseases. It is assumed that health will automatically improve if the diseases and their symptoms are eliminated. Steady progress on health outcome indicators of Pakistan is perhaps slightly negate this argument. Health care financing in Pakistan is mainly out-of-pocket. 3 This is prone to grassroots level inequities and suffering of the people by compromised and sometime denied care due to non-affordability. 4 Chronic diseases are key reason of impoverishment of families but this aspect of burden of diseases is lacking attention of health financing priorities of the government. The systems of regulation, quality and accountability of medical practice in both private and public sector are weak. Negligence in provision of medical care, inappropriate and unethical medical practice and daily practicing hours of the clinics go unchecked. 5 Medicine licensing, manufacturing and pricing system considers evidence on efficacy. 6 Pharmaceutical policy aims to promote pharmaceutical industry i.e. increased production …