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

doi:10.3390/ijerph15020242

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

^*Corresponding author for this work

Management Science

Research output: Contribution to journal › Article › peer-review

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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.

Original language	English
Article number	242
Number of pages	10
Journal	International Journal of Environmental Research and Public Health
Volume	15
Issue number	2
DOIs	https://doi.org/10.3390/ijerph15020242
Publication status	Published - 31 Jan 2018

Funding

Acknowledgments: We thank the Grand Challenge Canada for funding this study. icddr,b acknowledges with gratitude the commitment of Grand Challenge Canada to its research efforts. icddr,b is also thankful to the Governments of Bangladesh, Canada, Sweden and the UK for providing core/unrestricted support. Gratitude goes to Khandaker Mohammad Zahid and other field workers for their cordial cooperation for conducting this study. We are thankful to Jorge Martin del Campo of Johns Hopkins University for the language check.

Keywords

adverse selection
community based health insurance
EQ-5D

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10.3390/ijerph15020242Licence: CC BY 4.0

Ahmed-etal-IJERPH-2018-Adverse-selection-in-community-based-health-insurance-amongFinal published version, 636 KBLicence: CC BY 4.0

Cite this

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

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.",

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

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