Adverse selection in community based health insurance among informal workers in Bangladesh : an EQ-5D assessment

Ahmed, Sayem and Sarker, Abdur Razzaque and Sultana, Marufa and Chakrovorty, Sanchita and Hasan, Md Zahid and Mirelman, Andrew J. and Khan, Jahangir A.M. (2018) Adverse selection in community based health insurance among informal workers in Bangladesh : an EQ-5D assessment. International Journal of Environmental Research and Public Health, 15 (2). 242. ISSN 1661-7827 (

[thumbnail of Ahmed-etal-IJERPH-2018-Adverse-selection-in-community-based-health-insurance-among]
Text. Filename: Ahmed_etal_IJERPH_2018_Adverse_selection_in_community_based_health_insurance_among.pdf
Final Published Version
License: Creative Commons Attribution 4.0 logo

Download (651kB)| Preview


Community-based Health Insurance (CBHI) schemes are recommended for providing financial risk protection to low-income informal workers in Bangladesh. We assessed the problem of adverse selection in a pilot CBHI scheme in this context. In total, 1292 (646 insured and 646 uninsured) respondents were surveyed using the Bengali version of the EuroQuol-5 dimensions (EQ-5D) questionnaire for assessing their health status. The EQ-5D scores were estimated using available regional tariffs. Multiple logistic regression was applied for predicting the association between health status and CBHI scheme enrolment. A higher number of insured reported problems in mobility (7.3%; p = 0.002); self-care (7.1%; p = 0.000) and pain and discomfort (7.7%; p = 0.005) than uninsured. The average EQ-5D score was significantly lower among the insured (0.704) compared to the uninsured (0.749). The regression analysis showed that those who had a problem in mobility (m 1.25–2.17); self-care (OR = 2.29; 95% CI: 1.62–3.25) and pain and discomfort (OR = 1.43; 95% CI: 1.13–1.81) were more likely to join the scheme. Individuals with higher EQ-5D scores (OR = 0.46; 95% CI: 0.31–0.69) were less likely to enroll in the scheme. Given that adverse selection was evident in the pilot CBHI scheme, there should be consideration of this problem when planning scale-up of these kind of schemes.