Impact of Sehat Sahulat Program on Out-of-Pocket Health Expenditures in Pakistan

Abstract

Background: Out-of-pocket (OOP) health expenditures remain a major barrier to healthcare access in low- and middle-income countries, often pushing households into financial distress. Despite the implementation of health insurance initiatives like Pakistan’s Sehat Sahulat Program (SSP), evidence on its effectiveness in reducing direct patient costs remains limited and underexplored at the patient level. Objective: This study aimed to evaluate the impact of the Sehat Sahulat Program on OOP health expenditures among patients with high-cost chronic conditions—kidney failure, cancer, and cardiovascular diseases—by comparing pre- and post-intervention financial burdens. Methods: This was a cross-sectional, observational study conducted in three divisions of Punjab (Lahore, Rawalpindi, and Sargodha) with a sample size of 183 participants selected via random sampling. Inclusion criteria were adults receiving regular dialysis, chemotherapy, or cardiac treatment before and after the resumption of SSP services. Data were collected via structured questionnaires using the recall method. Ethical approval was obtained, and informed consent was taken from all participants in accordance with the Declaration of Helsinki. Paired sample t-tests and linear and multivariate regression analyses were conducted using Stata to assess the program’s financial impact. Results: The mean monthly OOP expenditure reduced significantly from PKR 72,139.15 (SD = 30,691.38) to PKR 13,390.95 (SD = 1,892.74), reflecting a decrease of PKR 58,748.19 (p < 0.001). Regression models confirmed the program as the primary determinant of cost reduction (R² = 0.78–0.79), independent of sociodemographic factors. Conclusion: The Sehat Sahulat Program effectively mitigates catastrophic health expenditures and financial distress among patients with chronic conditions, underscoring its critical role in promoting equitable healthcare access in Pakistan. These findings support SSP’s clinical relevance and policy value as a scalable model for achieving universal health coverage.