ArticleFrontiers in public health2025
The law of diminishing marginal returns in health insurance: evidence on child health outcomes from Pakistan's Sehat Sahulat program.
Article in Frontiers in public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed.
- Mpox Awareness and Knowledge Among Residents of the Northern Border Region, Saudi Arabia: Implications for Community Preparedness.Journal of community health · 2026Article
- Mapping the digital determinants of health: a machine learning analysis of YouTube narratives on child undernutrition in Pakistan.Journal of global health · 2026Article
- Modelling the impact of dietary diversity on child nutrition in Pakistan: a machine learning analysis with Shapley Additive exPlanations and Boruta interpretability.Journal of global health · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Child malnutrition remains a serious public health challenge in Pakistan. The national health insurance initiative, the Sehat Sahulat Program (SSP), aims to improve access to health care for low-income families. This study examines whether the effectiveness of SSP follows the Law of Diminishing Marginal Returns (LDMR), whereby the marginal health benefits of insurance are greatest for the poorest households and decline with increasing wealth. Methods: We analyzed data on 4,499 children under 5 years of age in the Pakistan Demographic and Health Survey 2017-18. To address endogeneity and wealth-based heterogeneity, we employed an IV-Probit model and an IV-Quantile Regression (IV-QR) across wealth quintiles, using community-level internet access and distance to the nearest health facility as instrumental variables. Logistic regression was applied as a baseline model. Results: Analysis reveals a strong gradient in the effectiveness of SSP program. Insurance coverage is associated with reduced stunting and marked declines in diarrhea rates among the poorest households. These benefits have diminished in the overall distribution of wealth and have become statistically insignificant for the richest quintile. Econometric tests have confirmed a clear pattern of declining marginal returns. Conclusion: The Sehat Sahulat project is a very effective tool for reducing malnutrition among poor children in Pakistan. The observed pattern of diminishing returns suggests that SSP provides the greatest health benefits to the poorest households. These findings support a pro-poor targeting strategy in Pakistan to maximize the program's impact within resource constraints.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.