The most recent wave of the household panel survey which is organised by the population panel working group of our research consortium provides interesting new insights on rising healthcare costs and how they impacted health care utilization in Khyber Pakhtunkhwa (KP), Pakistan.

In late 2023, we re-interviewed around 650 households from our panel, covering 3,753 people across Mardan, Malakand, Kohat, and Chitral, to monitor the development of their outpatient care use and financial burden related to healthcare expenditures. All of the surveyed households belong to the poorest part of the population in the province. Our findings revealed that outpatient visit rates dropped significantly from on average 0.85 visits per person per month in 2022 to 0.48 in 2023. Interestingly, while the number of visits per person decreased, the proportion of people seeking care stayed constant. This shift suggests that the same share of people still seek healthcare but are visiting less frequently.

Our analyses further revealed that the primary reason for seeking care among the surveyed households remained illness, with a smaller portion of visits related to accidents, preventive needs, or childbirth. Additionally, OPD services were utilized more frequently by women, elderly individuals, and those with chronic conditions. The data also showed a significant move towards informal care, with more people opting for pharmacy visits over primary healthcare facilities indicating that visits to primary care facilities are possibly substituted by pharmacy visits.

Our analysis of out-of-pocket expenditures (OOPE) highlighted that the cost for an average outpatient visit increased sharply in 2023 as compared to 2022. Even after adjusting for inflation, the OOPE per visit remained substantially higher, with medication costs taking the largest share of spending. Furthermore, we observe that in real terms, outpatient care expenditures increased only for private facilities, while they remained constant for public facilities.

Overall, our findings indicate a decreased health care demand for outpatient care and a shift from formal to informal healthcare options, which might be explained by the rising out-of-pocket expenditures that the people in KP province face. The population would hence benefit from increased social health protection covering costs of their outpatient care visits.  

 

Here is the link to the policy brief: https://blogs.fau.de/inspirepakistan/files/2024/11/Policy-Brief-6_OPD-Care-Utilization.pdf