Heterogeneous impact of health insurance on children’s nutritional status: insights from Instrumental Variable Quantile Regression (IV-QR) approach

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. 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. 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. 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.