Beyond the operating room: Comparing surgical outcomes of a public insurance programme in Khyber Pakhtunkhwa

Objective: To estimate the utilization of public insurance for surgical interventions in Khyber Pakhtunkhwa, Pakistan, and compare surgical outcomes between insured and uninsured patients. Methods: We retrospectively extracted data from one public and three private tertiary hospitals of Khyber Pakhtunkhwa (KP) that are empanelled under the Sehat Card Plus (SCP) Programme. Secondary Data was collected for a period of 16 months, from 1st June 2021 to 30th September 2022 both electronically and manually. The data collection process took place from October 2022 to December 2022. Patients undergoing exploratory laparotomy, lower (uterine) segment caesarean section (LSCS), or open reduction internal fixation (ORIF) of fractures were included. Extracted data included demographic details, payment status (SCP user/non-user), and surgical outcomes [in-hospital mortality, length of stay (LOS), 14- and 30-day readmission]. Multivariable regression models were created to determine the association of SCP use with surgical outcomes. Results: Records of 1,853 patients were analysed. The mean age was 28.74 +/- 12.75 years. A total of 582 (31.41%) patients utilized SCP for their treatment,429 (73.71%) of whom underwent LSCS. Overall mortality rate was 17 (0.92%). Compared with SCP non-users, SCP users had a significantly higher LOS (standardised beta: 0.52, 95% CI: 0.08-0.97) and lower 14-day readmission rate (OR: 0.64, 95% CI: 0.41-1.00). However, no significant difference was observed for 30-day readmission. Conclusion: Significantly prolonged LOS in SCP users can lead to over-utilisation of available assets. However, a lower 14day readmission rate was also noted among the SCP users. To ensure optimal outcomes among patients and adequate use of resources, continuous monitoring and changes are required for such public insurance programmes in low-resource settings.