DEPARTMENT OF ECONOMICS UNIVERSITY OF PESHAWAR
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Date
2026
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DEPARTMENT OF ECONOMICS UNIVERSITY OF PESHAWAR
Abstract
The Sehat Sahulat Programme (SSP), launched by the Government of Khyber Pakhtunkhwa in December 2015 and expanded to universal coverage from April 2020, is Pakistan's largest publicly-funded social health insurance scheme. This thesis evaluates its effect on physical well-being and economic resilience of poor households in KP using a concurrent mixed design that combines an eight-year administrative time-series (2018 to 2026) with a crosssectional primary survey of 500 to 600 beneficiary households at two comparator hospitals in Peshawar, one public general (Lady Reading Hospital) and one private empanelled (Northwest General Hospital). Findings from the administrative record show that SSP now covers approximately 10.6 million families, treated 1.08 million patients between January and November 2025, and has spent a cumulative PKR 135 billion since February 2016. The service mix is concentrated in tertiary categories, with cardiology alone accounting for roughly PKR 1.72 billion of programme expenditure. Pakistan's out-of-pocket share of current health expenditure stood at 52.93 per cent in 2023, third highest in South Asia, indicating that while reach has been substantively settled, the financial protection gap remains open. Primary-data patterns, flagged as preliminary pending fieldwork completion, suggest that private empanelled hospitals outperform public general hospitals on service experience but at a higher out-of-pocket cost, posing a trade-off that the scheme's current design does not resolve. The thesis recommends scaling the February 2025 outpatient pilot to all KP districts, re-pricing package rates to current costs, publishing claims data transparently, and integrating primary care into the benefits package as the highest-priority reforms. The study contributes the first combined administrative-and-household evaluation of Sehat Card Plus KP with a two-hospital comparator design.