INSPIRE Pakistan

Informing the Social Health Protection Initiative through Rigorous Evidence


Newly published in the Geneva Risk and Insurance Review: Does free hospitalization insurance change health care consumption of the poor? Short-term evidence from Pakistan

We are excited to see our paper published – online for now, but hopefully soon in the special issues “Risk Considerations and Insurance in Developing Countries”. In the paper, Prof. Dr. Andreas Landmann and Dr. Simona Helmsmüller study the effect of free hospitalization insurance on inpatient care consumption patterns. This was part of Phase 1 of the ongoing Social Health Protection Initiative (SHPI), which aimed at reducing financial barriers and increasing access of the poor to health services in selected districts of Pakistan’s Khyber Pakhtunkhwa (KP) province and the Gilgit Baltistan (GB) area through provision of free insurance coverage for inpatient health services (IPD). The program, which was launched in December 2015 in four pilot districts and then extended province-wide, covers the poorest 21% of households in the area through the delivery of insurance cards at fully subsidized rates.

In their research paper, Prof. Dr. Andreas Landmann and Dr. Simona Helmsmüller study how the fully subsidized hospitalization insurance provided during SHPI Phase 1 affects health service utilization of low-income households in Pakistan, focusing specifically on KP province. During the study period, the benefit package covered maternity-related care as well as non-maternity hospitalization, while it did not cover outpatient health services (OPD). The insured families could obtain the services both at public and private empaneled hospitals.

According to the main findings, the free hospitalization insurance did not significantly increase the quantity of health care consumption, despite high levels of neglected health care. However, the results indicate that households shifted their provider choice from public to private facilities, suggesting that the quality of private hospitals care is perceived as being higher than public care. This is consistent with a larger reduction of relative costs of private care, as well as with the small number of claims from public hospitals, indicating that public hospitals implemented the program less efficiently.
Overall, given the better resources and the higher client satisfaction associated with private hospitals, the results can be interpreted as an important and policy-relevant positive effect of the SHPI Phase 1, which might thus contribute to a more equitable access to high-quality care.

Read the full paper here:

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