Effect of a state-funded social health insurance programme, on equitable access to health care, financial risk protection and economic well-being in Khyber Pakhtunkhwa Province, Pakistan

Objective: To determine the effect of the SCP on access to health care, financial risk protection and perceived economicwell-being among beneficiaries.Methods: Using a comparative, cross-sectional design, household survey was conducted across 10 districts of the KPprovince during Nov22-Feb23. A total of 3619 households were recruited in which at least one member had received SCPinpatient services (users=1874) and neighbourhood households where a hospitalized member did not use SCP inpatientservices (nonuser=1745). Generalised regression models were used for analyses after adjusting for the propensity scores.Results: Socio-economic and demographic differences were not found between SCP user and non-user groups. Comparedto SCP nonusers, SCP users were more likely to seek inpatient care from private hospitals and covered more distance to getto empanelled health facilities, stay longer in hospitals, especially for patients with chronic diseases and injuries. There wasa significant reduction in medical care component of mean out-of-pocket expenditure for inpatient services among SCPusers (PKR 1,006 ±9,248) as compared with SCP nonusers (PKR 30,042 ±69,014). The nonmedical component (transport etc.)was not substantively different in both groups. The level of catastrophic health expenditure was significantly lower amongSCP users 253 (14%) compared to SCP nonusers 621 (35%), leading to higher perceived economic wellbeing among SCPusers.Conclusion: KP Government’s SCP has been effective in improving financial risk protection among its beneficiaries, resultingin an increased sense of economic well-being, as compared to SCP nonusers. SCP needs to devise strategy to increase accessto inpatient services, particularly among poorer families to maximize its impact.Keywords: Sehat Card Plus (SCP), Financial Risk Protection, Inpatient Care, Out-of-Pocket Expenditure, CatastrophicHealth Expenditure.