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

Sayem Ahmed, Abdur Razzaque Sarker, Marufa Sultana, Sanchita Chakrovorty, Md Zahid Hasan, Andrew J. Mirelman, Jahangir A.M. Khan

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

LanguageEnglish
Article number242
Number of pages10
JournalInternational Journal of Environmental Research and Public Health
Volume15
Issue number2
DOIs
Publication statusPublished - 31 Jan 2018

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Bangladesh
Health Insurance
Self Care
Health Status
Pain
Logistic Models
Regression Analysis
Pilots
Surveys and Questionnaires

Keywords

  • adverse selection
  • community based health insurance
  • EQ-5D

Cite this

Ahmed, Sayem ; Sarker, Abdur Razzaque ; Sultana, Marufa ; Chakrovorty, Sanchita ; Hasan, Md Zahid ; Mirelman, Andrew J. ; Khan, Jahangir A.M. / Adverse selection in community based health insurance among informal workers in Bangladesh : an EQ-5D assessment. In: International Journal of Environmental Research and Public Health. 2018 ; Vol. 15, No. 2.
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Adverse selection in community based health insurance among informal workers in Bangladesh : an EQ-5D assessment. / Ahmed, Sayem; Sarker, Abdur Razzaque; Sultana, Marufa; Chakrovorty, Sanchita; Hasan, Md Zahid; Mirelman, Andrew J.; Khan, Jahangir A.M.

In: International Journal of Environmental Research and Public Health, Vol. 15, No. 2, 242, 31.01.2018.

Research output: Contribution to journalArticle

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