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Abstract：
BACKGROUND: Universal Health Coverage (UHC) is a common health policy objective outlined in the Sustainable Development Goals. With provincial governments taking the initiative, Pakistan has implemented and extended UHC program amid a complex public health landscape. In this context, we assess Pakistan\'s progress toward achieving UHC at the national and subnational level.
METHODS: We use data from the Demographic and Health Surveys and the Household Integrated Economic Survey to construct a UHC index at the national and subnational level for 2007, 2013, and 2018. Furthermore, we use Concentration Index (CI) and CI decomposition methodologies to assess the primary drivers of inequality in accessing medical services. Logistic regression and Sartori\'s two-step model are applied to examine the key determinants of catastrophic health expenditure (CHE).
RESULTS: Our analysis underscores Pakistan\'s steady progress toward UHC, while revealing significant provincial disparities in UHC progress. Provinces with lower poverty rate achieve higher UHC index, which highlights the synergy of poverty alleviation and UHC expansion. Among the examined indicators, child immunization remains a key weakness that one third of the children are not fully vaccinated and one sixth of these not-fully-vaccinated children have never received any vaccination. Socioeconomic status emerges as a main contributor to disparities in accessing medical services, albeit with a declining trend over time. Household socioeconomic status is negatively correlated with CHE incidence, indicating that wealthier households are less susceptible to CHE. For individuals experiencing CHE, medicine expenditure takes the highest share of their health spending, registering a staggering 70% in 2018.
CONCLUSIONS: Pakistan\'s progress toward UHC aligns closely with its economic development trajectory and policy efforts in expanding UHC program. However, economic underdevelopment and provincial disparities persist as significant hurdles on Pakistan\'s journey toward UHC. We suggest continued efforts in UHC program expansion with a focus on policy consistency and fiscal support, combined with targeted interventions to alleviate poverty in the underdeveloped provinces.
METHODS: We use data from the Demographic and Health Surveys and the Household Integrated Economic Survey to construct a UHC index at the national and subnational level for 2007, 2013, and 2018. Furthermore, we use Concentration Index (CI) and CI decomposition methodologies to assess the primary drivers of inequality in accessing medical services. Logistic regression and Sartori\'s two-step model are applied to examine the key determinants of catastrophic health expenditure (CHE).
RESULTS: Our analysis underscores Pakistan\'s steady progress toward UHC, while revealing significant provincial disparities in UHC progress. Provinces with lower poverty rate achieve higher UHC index, which highlights the synergy of poverty alleviation and UHC expansion. Among the examined indicators, child immunization remains a key weakness that one third of the children are not fully vaccinated and one sixth of these not-fully-vaccinated children have never received any vaccination. Socioeconomic status emerges as a main contributor to disparities in accessing medical services, albeit with a declining trend over time. Household socioeconomic status is negatively correlated with CHE incidence, indicating that wealthier households are less susceptible to CHE. For individuals experiencing CHE, medicine expenditure takes the highest share of their health spending, registering a staggering 70% in 2018.
CONCLUSIONS: Pakistan\'s progress toward UHC aligns closely with its economic development trajectory and policy efforts in expanding UHC program. However, economic underdevelopment and provincial disparities persist as significant hurdles on Pakistan\'s journey toward UHC. We suggest continued efforts in UHC program expansion with a focus on policy consistency and fiscal support, combined with targeted interventions to alleviate poverty in the underdeveloped provinces.
摘要：
背景：全民健康覆盖（UHC）是可持续发展目标中概述的共同卫生政策目标。随着省政府的主动，巴基斯坦在复杂的公共卫生环境中实施并扩展了UHC计划。在这种情况下，我们评估巴基斯坦在国家和国家以下各级实现全民健康覆盖的进展。
方法：我们使用来自人口与健康调查和家庭综合经济调查的数据，在2007年，2013年和2018年的国家和国家以下级别构建了UHC指数。此外，我们使用集中度指数(CI)和CI分解方法来评估获取医疗服务不平等的主要驱动因素.Logistic回归和Sartori的两步模型用于检查灾难性卫生支出（CHE）的关键决定因素。
结果：我们的分析强调了巴基斯坦在UHC方面的稳步进展，同时揭示了UHC进展的显著省际差异。贫困率较低的省份实现较高的UHC指数，这突出了扶贫和UHC扩张的协同作用。在审查的指标中，1/3的儿童没有完全接种疫苗,1/6的未完全接种疫苗的儿童从未接种过任何疫苗.社会经济地位成为获取医疗服务差距的主要原因，尽管随着时间的推移呈下降趋势。家庭社会经济地位与CHE发病率呈负相关，表明较富裕的家庭较不容易受到CHE的影响。对于经历CHE的人来说，医药支出占他们医疗支出的最高份额，2018年登记了惊人的70%。
结论：巴基斯坦在UHC方面的进展与其经济发展轨迹和扩大UHC计划的政策努力密切相关。然而,经济欠发达和省级差距仍然是巴基斯坦迈向UHC的重大障碍。我们建议继续努力扩大UHC计划，重点是政策一致性和财政支持，结合有针对性的干预措施，以减轻欠发达省份的贫困。
方法：我们使用来自人口与健康调查和家庭综合经济调查的数据，在2007年，2013年和2018年的国家和国家以下级别构建了UHC指数。此外，我们使用集中度指数(CI)和CI分解方法来评估获取医疗服务不平等的主要驱动因素.Logistic回归和Sartori的两步模型用于检查灾难性卫生支出（CHE）的关键决定因素。
结果：我们的分析强调了巴基斯坦在UHC方面的稳步进展，同时揭示了UHC进展的显著省际差异。贫困率较低的省份实现较高的UHC指数，这突出了扶贫和UHC扩张的协同作用。在审查的指标中，1/3的儿童没有完全接种疫苗,1/6的未完全接种疫苗的儿童从未接种过任何疫苗.社会经济地位成为获取医疗服务差距的主要原因，尽管随着时间的推移呈下降趋势。家庭社会经济地位与CHE发病率呈负相关，表明较富裕的家庭较不容易受到CHE的影响。对于经历CHE的人来说，医药支出占他们医疗支出的最高份额，2018年登记了惊人的70%。
结论：巴基斯坦在UHC方面的进展与其经济发展轨迹和扩大UHC计划的政策努力密切相关。然而,经济欠发达和省级差距仍然是巴基斯坦迈向UHC的重大障碍。我们建议继续努力扩大UHC计划，重点是政策一致性和财政支持，结合有针对性的干预措施，以减轻欠发达省份的贫困。
