In Pakistan, Asher Hasan brings innovation to health-care cost, at $1.80 per month

Wilayat Shah, a security guard at the luxury Avari Towers Hotel in Karachi, Pakistan, was rushed to a hospital last December after experiencing headaches and losing consciousness at work.

Unlike the wealthy patrons of the hotel he guarded, the father of four wouldn't ordinarily have had access to top-notch medical treatment.

But thanks to a health-care program run by the nonprofit Naya Jeevan (New Life), Mr. Shah, who earns just $150 a month, paid nothing for the MRI scans and treatment he received, worth some $1,400. He now has returned to work.

Shah is one of some 13,000 low-income workers in Pakistan signed on to the Naya Jeevan program. It was founded in 2007 by surgeon-turned-social entrepreneur Asher Hasan and began operating in Pakistan last summer.

"In Pakistan, privileged people can afford their care," Dr. Hasan explains. "The poor, who work alongside the rich, were just excluded from the system."

Hasan left a successful career in the United States to return to Pakistan, where he had spent his formative years, on a mission to provide affordable health care to low-income workers.

He lived a "clichéd life," he says, with a résumé that includes an MBA from New York University, research work at Harvard Medical School, and a stint as a senior executive at a California-based pharmaceutical company.

"I knew there was much more I could be doing in Pakistan," Hasan says.

By working with insurance companies to spread risk across clusters of low-income workers, who typically earn less than $200 a month, Naya Jeevan opens up high-quality health care to a segment of the population that couldn't afford it before.

Each participant pays in about $1.80 per month. The maximum catastrophic payout is $1,800 per year – the average cost of heart bypass surgery at a good private hospital in Pakistan, Hasan says.

That low monthly premium, which he calculates as roughly 2.1 percent of the monthly income of the working poor, as well as the absence of deductibles and copayments, is "commendable," says Farasat Bokhari, a Pakistani-American health economist at King's College in London.

"More impressive is the fact that they have contracts with a large number of private hospitals, which are presumably of higher quality compared with the public hospitals, which are severely underfunded," Mr. Bokhari says.

Last year, the Pakistani government spent an average of $18 per person for health care, one of the consequences of its struggle to deal with an ongoing battle against Islamist insurgents on its western border and the aftermath of last year's catastrophic floods.

Across the developing world, catastrophic illnesses can wreak havoc on families, who may be forced to sell their most valuable possessions or pull their children out of school to pay medical bills.

Hasan has first-hand experience. Born in London into a middle-class family, his mother moved him and his three sisters to Karachi following the death of their father in 1983. On a trip back to Britain, Hasan's mother suffered a nervous breakdown. She had no contact with her children for the next three years.

During this time, Hasan grew close to the children of his maid. While his education was provided for by the colleagues and friends of his late father, his maid was unable to tap any wealthy connections when her father fell seriously ill, forcing her to withdraw her children from school.

"I realized that a single catastrophic event can lead to the perpetuation of the cycle of poverty," he says. "We had to create a system which could break that cycle."

Pakistan's failure to bridge its rich-poor divide is a source of class resentment that some say plays into the hands of the country's extremists, including the Taliban. The killing in January of liberal politician Salman Taseer exposed the fault lines, as the wealthy English-speaking classes took to the streets to protest his death. Pakistan has not done enough to bring about "economic democracy," critics say – thus generating recruits for Islamist extremists.

The Naya Jeevan program isn't perfect. Outpatient care is not provided, pre-­existing conditions are covered only in certain cases, and the upper limit of $1,800 per year means patients may not be able to afford follow-up care after an expensive hospital stay, says Bokhari, the health economist.

"Incidentally, this was also a shortcoming of the early days of Medicare hospital coverage plans in the US," he adds.

Naya Jeevan has paid for such extra costs through donations. But Hasan hopes to expand the scope of the insurance plan over time. The program will reach a fiscal break-even point when 75,000 people are signed up, Hasan explains, almost six times the number of current participants.

The next step after that, he says, will be to work with other major institutions to sign up 2.5 million Pakistanis and lobby the federal government to set up a similar program of private health-care insurance nationwide.

• Naya Jeevan is at nayajeevan@njfk.org

• For more stories about people making a difference, go here.