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 (https://doi.org/10.3390/ijerph15020242)
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Abstract
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.
ORCID iDs
Ahmed, Sayem, Sarker, Abdur Razzaque ORCID: https://orcid.org/0000-0002-9594-7859, Sultana, Marufa, Chakrovorty, Sanchita, Hasan, Md Zahid, Mirelman, Andrew J. and Khan, Jahangir A.M.;-
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Item type: Article ID code: 63636 Dates: DateEvent31 January 2018Published29 January 2018AcceptedSubjects: Medicine > Public aspects of medicine > Public health. Hygiene. Preventive Medicine Department: Strathclyde Business School > Management Science Depositing user: Pure Administrator Date deposited: 06 Apr 2018 11:31 Last modified: 11 Nov 2024 11:57 Related URLs: URI: https://strathprints.strath.ac.uk/id/eprint/63636