{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:05:53Z","timestamp":1792508753812,"version":"4.5.0"},"reference-count":83,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data on 4,499 children under 5\u202fyears of age in the Pakistan Demographic and Health Survey 2017\u201318. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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\u2019s impact within resource constraints.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1729440","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:13:54Z","timestamp":1768205634000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["The law of diminishing marginal returns in health insurance: evidence on child health outcomes from Pakistan\u2019s Sehat Sahulat program"],"prefix":"10.3389","volume":"13","author":[{"given":"Muhammad","family":"Shahid","sequence":"first","affiliation":[{"name":"College of Management, Shenzhen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafiz Muhammad","family":"Naveed","sequence":"additional","affiliation":[{"name":"College of Management, Shandong University of Finance and Economics","place":["Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayi","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, McGill University","place":["Montreal, QC, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serhat","family":"Yuksel","sequence":"additional","affiliation":[{"name":"School of Business, Istanbul Medipol University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan","family":"Dincer","sequence":"additional","affiliation":[{"name":"School of Business, Istanbul Medipol University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Economics, Al-Madinah International University","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/S0140-6736(13)60937-X","article-title":"Maternal and child undernutrition and overweight in low-income and middle-income countries","volume":"382","author":"Black","year":"2013","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1186\/s13643-019-1112-7","article-title":"Past drivers of and priorities for child undernutrition in South Asia: a mixed methods systematic review protocol","volume":"8","author":"Wali","year":"2019","journal-title":"Syst Rev"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2320","DOI":"10.1080\/10408398.2013.832143","article-title":"Malnutrition in South Asia - 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