Exploring the Potential Causal Relationship Between Health Insurance Coverage and Child Nutritional Status in Pakistan: Evidence from PDHS-2018.

the current study investigates the link between health insurance coverage and child nutritional status in Pakistan. Using data from the Pakistan Demographic and Health Survey (PDHS) 2017-18, encompassing 4499 children under 5, a binary logistic regression was applied to analyze the relationship between health insurance and child nutritional status. Due to the non-randomized sample, assessing health insurance continuously posed a practical challenge. To mitigate the sample selection bias, the cross-sectional-based propensity score matching (PSM) using the nearest neighbor method was utilized for the causal relationship, based on potential socio-economic covariates. The prevalence rates of stunting, underweight, and wasting among children under five were 38.13%, 23.04%, and 8.05%, respectively. Malnutrition was found in 43.64% of non-insured children compared with 5% in insured children. The findings of PSM supported a causal relationship, given the cross-sectional nature and potential misplaced variables, as the PSM findings revealed that insured children had significantly better nutritional outcomes compared with non-insured children, with a significance level of 1%. The logistic regression outcomes for the covariates of child nutritional outcome indicated that health insurance coverage, higher wealth status, mother's education, improved water and sanitation facilities, mother's normal BMI, and urban residence reduced the likelihood of child malnutrition. The logistic regression results for the covariates of child health insurance depicted that factors such as higher birth order, mother's low BMI, poor water and sanitation facilities, higher wealth status, women's employment, higher education level, and child illnesses like diarrhea and malnutrition increased the likelihood of obtaining health insurance. The logistic results confirmed that health insurance coverage reduced the likelihood of child malnutrition, and, similarly, child malnutrition and other illnesses increased the chances of obtaining health insurance coverage. The findings underscore the critical need for health insurance, highlighting its role in enhancing child nutritional status. The government should expand health insurance programs, with a special emphasis on child nutrition and health.