Economic Inequality as a Barrier in the Patient's Health Services Utilization in South Punjab Pakistan

Abstract

This paper examined economic factors influence health services use and patient health outcomes and explore the mediating role of healthcare use in this relationship, with rural South Punjab as the case study.  A cross-sectional, quantitative survey was carried out on 385 patients, who were recruited in three public tertiary care hospitals, namely, Nishtar Hospital (Multan), Victoria Hospital (Bahawalpur) and DHQ Hospital (Dera Ghazi Khan). Multistage sampling method was used. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to analyze the data with SmartPLS 4.  The demographic profile indicated deep economic insecurity: 46.8% of the respondents indicated that their household income was less than PKR 20,000 per month, and 39.0% were unemployed. The PLS-SEM analysis proved that economic factors have a strong direct positive impact on the use of health services (β = 0.381, t = 12.842, p = 0.001) and a strong direct impact on patient health (β = 0.208, t = 5.321, p = 0.001). Moreover, the use of health services partially mediated the relationship between economic factors and patient health outcomes (indirect effect: 0.109 5.132 p < 0.001). All model fit indices were satisfactory. The economic inequality is a structural factor that inhibits the use of healthcare and hence negatively impacts the health of the patients. The solution to financial barriers is to increase health equity in South Punjab by providing universal health insurance, specific subsidies, and decreasing indirect costs. The research adds empirical data to the Behavioral Model of Andersen and the Social Determinants of Health framework in the context of a low-middle-income country.