Key points
- Pakistan runs a mixed system: a public-private hybrid, with the Sehat Sahulat Program as the main public insurance scheme and most care still paid for out of pocket.
- Coverage is uneven by province: the Sehat Sahulat Program, launched in 2015, covered about 44.6 million households by 2022, but Punjab suspended it in public hospitals in July 2025.
- Care is delivered by basic health units and rural health centres for primary care, and by district, tehsil and major hospitals — with GPs, mostly private, providing about 71% of primary care.
- Sehat Card holders get inpatient care covered where the programme still runs, but households still paid 52.9% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database).
- Life expectancy at birth was 68.2 years in 2023, and health spending was 2.5% of GDP in 2023 (WHO Global Health Estimates; World Bank, WHO Global Health Expenditure Database).
Direct answer: Pakistan runs a mixed system: a public-private hybrid, with the Sehat Sahulat Program as the main public insurance scheme and most care still paid for out of pocket. Coverage is uneven by province: the Sehat Sahulat Program, launched in 2015, covered about 44.6 million households by 2022, but Punjab suspended it in public hospitals in July 2025. Care is delivered by basic health units and rural health centres for primary care, and by district, tehsil and major hospitals — with GPs, mostly private, providing about 71% of primary care. Sehat Card holders get inpatient care covered where the programme still runs, but households still paid 52.9% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database). Life expectancy at birth was 68.2 years in 2023 — and healthy life expectancy 58.4 years — and health spending was 2.5% of GDP in 2023 (WHO Global Health Estimates, October 2026; World Bank, WHO Global Health Expenditure Database).
At a glance
| Item | Detail |
|---|---|
| Model | Mixed — public-private hybrid (Sehat Sahulat Program) |
| Who pays | Provincial tax revenues funding the Sehat Sahulat Program, employer contributions to the provincial employees' social security institutions, and out-of-pocket payments on top |
| Who delivers | Basic health units and rural health centres for primary care; district and tehsil hospitals for secondary care; major hospitals and specialised institutions for tertiary care |
| What is free at the point of use | Inpatient care for Sehat Card holders where the programme still runs, up to PKR 460,000 per family |
| Life expectancy at birth | 68.2 years (2023, WHO Global Health Estimates) |
| Health spending | 2.5% of GDP (2023, World Bank, WHO Global Health Expenditure Database) |
| Source for the model and coverage | Commonwealth Fund — Pakistan country profile |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
Pakistan’s system is a federal one: four provinces, the Islamabad Capital Territory and two self-governing regions run their own services, with the Ministry of National Health Services, Regulations and Coordination — created in 2012 — at the federal level. Rural health centres were created in the 1960s and basic health units in the 1980s, and since 2000 non-governmental organisations and public-private partnerships have extended the system further. The move towards universal health coverage began in 2015, when Khyber Pakhtunkhwa launched the Sehat Sahulat Program (SSP); the federal government expanded it to other provinces from 2019, and by 2022 it covered about 44.6 million households (Commonwealth Fund).
The first point of contact is primary care at basic health units, rural health centres and family welfare centres, covering preventive care, maternal and child health, immunisations and common illnesses. GPs provide about 71% of primary care services, most of them in the private sector. Secondary care is delivered through district and tehsil hospitals, and tertiary care through major hospitals and specialised institutions. There is no formal gatekeeping mechanism, so referral from primary care is weak and district hospitals often act as the first point of care.
Who pays, and what people pay
The SSP is administered by the State Life Insurance Corporation of Pakistan and fully subsidised through provincial tax revenues; beneficiaries use the Sehat Sahulat card as proof of enrolment, and the programme typically provides PKR 460,000 (USD 1,620) per family, mainly for inpatient hospital care. Formally employed workers are covered separately by the provincial employees’ social security institutions — the Punjab Employees Social Security Institution and the Khyber Pakhtunkhwa Employees Social Security Institution — funded by employer contributions of 6% and 7% of wages respectively. In 2022 total health expenditure was about USD 10 billion, with government spending at USD 3.77 billion (38.2% of the total), or USD 16 per person of USD 41 per capita. What people still pay dominates: households paid 52.9% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database). Outpatient services are largely uncovered, so patients pay for them directly, and since July 2025 Punjab-based Sehat Card holders have been unable to access free treatment in public hospitals in Punjab — the province withdrew from the SSP in favour of its own Chief Minister’s initiatives covering high-cost treatments such as paediatric heart surgery, dialysis and organ transplants.
What is free, and what is not
Where the SSP still runs, inpatient care is free at the point of use for card holders, under two packages: priority treatment — including heart disease, cancer, dialysis, end-stage kidney disease, chronic infections and neurosurgery — and secondary care, including inpatient services and emergency treatment. What is not free is the margin: primary and outpatient care are not covered by the SSP (a pilot to extend cover to outpatient and primary care began in the Islamabad Capital Territory in 2021), medicines and diagnostics outside the packages are paid for directly, and the programme’s reach depends on the province — Punjab’s July 2025 suspension ended free treatment in public hospitals there, so the same card that covers a hospital stay in one province may not in another.
How it compares
Pakistan spends 2.5% of GDP on health (2023), the lowest share in this set and well below the OECD average of 9.3% (2024), and its life expectancy of 68.2 years is 12.9 years below the OECD average of 81.1 years (2023). Pakistan is not in the OECD tables, so its figures come from WHO and World Bank sources for 2023 rather than the OECD’s 2024 dashboards. Its distinguishing feature is how much of the bill still falls on households: out-of-pocket spending of 52.9% is the second-highest share in this set, after Nigeria (71.9%), on the thinnest budget in the set — and the public scheme meant to close that gap is decided province by province, so cover depends on where a patient lives. Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
What is the Sehat Sahulat Program?
Pakistan's government-led social health insurance programme, launched in 2015 in Khyber Pakhtunkhwa and expanded federally from 2019. It is administered by the State Life Insurance Corporation and fully subsidised through provincial tax revenues, and it typically provides PKR 460,000 per family, mainly for inpatient hospital care.
What does the Sehat Card cover?
Where the programme still runs, the Sehat Card covers inpatient care under two packages — priority treatment (including heart disease, cancer, dialysis and organ failure) and secondary care (including inpatient services and emergency treatment). Primary care is not covered, except for a pilot in the Islamabad Capital Territory.
Do patients pay out of pocket?
Yes, heavily: households paid 52.9% of health spending out of pocket in 2023, the second-highest share in this set after Nigeria. Outpatient services are largely uncovered, so patients pay for them directly, and Punjab's July 2025 suspension ended free treatment in public hospitals there for Sehat Card holders.