Distance and health facility choice: Evidence from a health micro insurance program in Punjab, Pakistan

Health micro insurance offers a promising mechanism to protect the poor against risk and vulnerability arising from catastrophic healthcare expenditures. In light of this, we study the relationship between physical distance to hospitals and the choice of healthcare services in the context of a health micro insurance program in Punjab, Pakistan. We address three main research questions; first, how does physical distance affect choice of health facility? Second, is the burden of physical distance greater for women? Third, can the diffusion of information in social networks be a potential mechanism for reducing the burden of distance? We employ a Probit model with administrative data on hospitalisation claims made between 2014 and 2017. Our findings show that distance impedes individuals from making panel (cashless) claims and thus increases the likelihood of out-of-pocket expenditures at nearby non-panel hospitals. This adverse effect is more pronounced for women as compared to men. Dissemination of information in social networks increases the usage of panel facilities, especially by women. Hence, this can be an effective mechanism in reducing the role that distance plays in the choice of health facility.