The Plight of the Uninsured- my dear health care , is very elementary.

From Boston to Karachi , people struggle to perfect a model of health care formula for the uninsured , to create a sustainable access to clinical care. At my school in boston , I learned from my Professor, that the number of uninsured in America has increased from 40.6 million in 1995 to 45.7 million in 2007. The rate of uninsurance also varied from across states ( 2006-2007) : MA being the lowest at 8% and TX being the highest at 25%. The number of uninsured is increasing because of structural changes in the economy as the trend is moving from manufacturing jobs to service jobs. There is also an increase in part-time or contract jobs. There is a decrease in the family 's median income. Health insurance is becoming expensive. The are employer cut backs in insurance coverage. People who are generally found to be uninsured are: low income groups; unemployed, part time and new jobs ; less educated ; non documented immigrants; more recent legal immigrants.
There is ofcourse compelling evidence of being uninsured and ill health. People either post pone seeking health care because of cost ; did not fill out a precription because of cost; had problems paying medical bills. As the professor mentioned in one of the lectures: Ideas are many about what could be done: Expand medicaid progams for the low income groups ; expand medicare to young age groups ;Expand employer based coverage; expand individual coverage and introduce a single payer system. Majority of the public health opinion is in favour of the goal: " health care should be provided equally to every one just as public education is " ( 2000) . However, coming to a consensus regarding the best solution is challenging. According to a survey 2003: 85% favour Tax credit for businesses , 72% favour the tax credits for individual , 64% favoured exonading medicare to less than 65 years of age , and 47% favour a national single payer plan. What is more interesting is the result of the survey of Kaiser / HSPH regarding willingness to pay to help the uninsured, either in higher health insurance premiums or higher taxes so that there can be an increased number of insured in America.....51% said "no, not willing to pay" and and 45% said " yes willing to pay."
Spanning across continents, my Professor in Pakistan designed the first ever health insurance for the poor as a pilot project. The project is now launched in 16 districts and we await to see how effective is the implementation of the program and how much is the utilization of the services.
Pakistan’s population is more than 170 Million; in 2008 with an annual growth rate of almost 2.4%. Literacy rate is about 54% according to government estimates .Inflation rate is more than 25% in 2009: the cost of living is becoming out of control for majority of the people. Monthly minimum wage is Rs. 6,000 (US $ 73) per month. Afert designing an inclusion criterion , It is proposed that eligible family units be enrollment with the entitlement of the family being up to Rs.25, 000 year.The premium for each family is anticipated at Rs.500 per annum .
This health insurance scheme would be operated through insurance companies selected by competitive bidding of premium for provision of service in a block of Districts designated bythe central fund providing/management authority , at the start up but eventually in each Administrative Division of the country. The envisaged insurance scheme for the poor would require involvement of the central fund providing authority, the participating insurance companies, the Federal and Provincial Health authorities, the health care providers and the beneficiaries linked by an information technology backbone with a chip-enabled card as its central features.
What we would need in Pakistan is a strong political will and proper administerative capacity.
Waiting and hoping that this would be an effective beginning to adressing the issue of the uninsured that spans form the developed world to the developing world.

Notes:
(a) Lecture presentation by Prof Nancy Turnbull- HSPH
(b) Lecture presentation by Prof Rasheed Jooma- Director General Pakistan