Heterogeneous impact of health insurance on children’s nutritional status: insights from Instrumental Variable Quantile Regression (IV-QR) approach
8 affiliations
- 1College of Management, Shenzhen University
- 2Department of Family Medicine, McGill University
- 3Department of Artificial Intelligence, School of Computing, The Islamia University of Bahawalpur
- 4Department of Management, College of Business Administration, Princess Nourah bint Abdulrahman University
- 5School of Management Science and Engineering, Shandong University of Finance and Economics
- 6Department of Economics, Al-Madinah International University
- 7College of Economics & Management, Beijing University of Technology
- 8Institute for Global Health and Development, Peking University
Abstract
Objective Empirically, this study focuses on the impact assessment of health insurance uptake on the nutrition of kids under five with special attention to variation in wealth level in Pakistan. Theoretical frameworks argue that health insurance provides a safety net against poor health outcomes. Methods We analyzed 4,499 children from the Pakistan Demographic and Health Survey (2017-18) using Instrumental Variable Quantile Regression (IV-QR) along with logistic and probit models as bassline, with internet access and distance to health facility as instruments. This approach addresses endogeneity while examining heterogeneity across the nutritional distribution. Results The outcomes of the study are based on probit and logistic estimations. Health insurance in general and the Sehat Sahulat scheme in particular among the poor and most wealthy people in Pakistan greatly increases the positive health outcomes and nutrition of children. The Sehat Sahulat scheme of health insurance coverage of the malnourished children in the low economic class in rural and urban Pakistan provides substantial protection from malnutrition. The IV-QR results reveal that health insurance significantly reduces child malnutrition only for the poorest three wealth quintiles (Q1: OR = 0.64, p < 0.01; Q2: OR = 0.75, p < 0.01; Q3: OR = 0.41, p < 0.01), with no significant effect for wealthier households. The Sehat Sahulat program shows protective effects exclusively for low-income groups, confirming effective targeting. This study assesses the impact of health insurance uptake on child nutrition among children under five in Pakistan, with particular attention to variation across wealth groups. Conclusion The Sehat Sahulat program effectively targets vulnerable populations, but persistent geographic disparities indicate that insurance alone is insufficient. Policymakers should expand coverage while investing in complementary sanitation, education, and region-specific interventions.
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BibTeX
@article{shahid2026heterogeneous,
title = {{Heterogeneous impact of health insurance on children’s nutritional status: insights from Instrumental Variable Quantile Regression (IV-QR) approach}},
author = {Muhammad Shahid and Jiayi Song and Muhammad Ali Yahya and Zaiba Ali and Hafiz Muhammad Naveed and Muhammad Ali and Muneeb-Ur-Rehman Tahir and Ermo Chen},
journal = {Health Economics Review},
year = {2026},
month = jul,
doi = {10.1186/s13561-026-00828-7},
url = {https://doi.org/10.1186/s13561-026-00828-7},
note = {CC BY},
}
RIS
TY - JOUR
TI - Heterogeneous impact of health insurance on children’s nutritional status: insights from Instrumental Variable Quantile Regression (IV-QR) approach
AU - Muhammad Shahid
AU - Jiayi Song
AU - Muhammad Ali Yahya
AU - Zaiba Ali
AU - Hafiz Muhammad Naveed
AU - Muhammad Ali
AU - Muneeb-Ur-Rehman Tahir
AU - Ermo Chen
PY - 2026
DA - 2026/07/01
JO - Health Economics Review
DO - 10.1186/s13561-026-00828-7
UR - https://doi.org/10.1186/s13561-026-00828-7
AB - Objective Empirically, this study focuses on the impact assessment of health insurance uptake on the nutrition of kids under five with special attention to variation in wealth level in Pakistan. Theoretical frameworks argue that health insurance provides a safety net against poor health outcomes. Methods We analyzed 4,499 children from the Pakistan Demographic and Health Survey (2017-18) using Instrumental Variable Quantile Regression (IV-QR) along with logistic and probit models as bassline, with internet access and distance to health facility as instruments. This approach addresses endogeneity while examining heterogeneity across the nutritional distribution. Results The outcomes of the study are based on probit and logistic estimations. Health insurance in general and the Sehat Sahulat scheme in particular among the poor and most wealthy people in Pakistan greatly increases the positive health outcomes and nutrition of children. The Sehat Sahulat scheme of health insurance coverage of the malnourished children in the low economic class in rural and urban Pakistan provides substantial protection from malnutrition. The IV-QR results reveal that health insurance significantly reduces child malnutrition only for the poorest three wealth quintiles (Q1: OR = 0.64, p < 0.01; Q2: OR = 0.75, p < 0.01; Q3: OR = 0.41, p < 0.01), with no significant effect for wealthier households. The Sehat Sahulat program shows protective effects exclusively for low-income groups, confirming effective targeting. This study assesses the impact of health insurance uptake on child nutrition among children under five in Pakistan, with particular attention to variation across wealth groups. Conclusion The Sehat Sahulat program effectively targets vulnerable populations, but persistent geographic disparities indicate that insurance alone is insufficient. Policymakers should expand coverage while investing in complementary sanitation, education, and region-specific interventions.
SN - 2191-1991
ER -