Making Health Insurance Responsive to Citizens to Improve Enrolment and Utilization: Learning for Universal Health Insurance in Pakistan

Abstract

Health utilization largely depends on both demand and supply-side factors, where affordability is critical, especially for the poor segments. The Sehat Sahulat Program (SSP) is a breakthrough in Pakistan that aims to provide free indoor health services to the population. The present study has analyzed the factors that can adversely impact the utilization of indoor health services, including challenges related to enrolment, communication, awareness, and other supply-side factors. Besides conducting in-depth interviews with supply-side stakeholders, the study also conducts a household survey with the beneficiaries. The analysis reveals that the program still has a catch-up potential where a significant population is not enrolled in the program, and many of them are deprived of treatment. We consider that the program should opt for a co-payment formula to create a health insurance market in the country. To better utilize the program, a comprehensive consultative process among stakeholders is required to address design and operational inefficiencies.