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Do employer-sponsored health insurance schemes affect the utilisation of medically trained providers and out-of-pocket payments among ready-made garment workers? A case-control study in Bangladesh

Ahmed, Sayem, Sarker, Abdur Razzaque, Sultana, Marufa, Roth, Felix, Mahumud, Rashidul Alam, Kamruzzaman, Md, Hasan, Md Zahid, Mirelman, Andrew J., Islam, Ziaul, Niessen, Louis W., Rehnberg, Clas, Khan, AK Azad, Gyr, Niklaus and Khan, Jahangir A.M. 2020, Do employer-sponsored health insurance schemes affect the utilisation of medically trained providers and out-of-pocket payments among ready-made garment workers? A case-control study in Bangladesh, BMJ Open, vol. 10, pp. 1-12, doi: 10.1136/bmjopen-2019-030298.

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Title Do employer-sponsored health insurance schemes affect the utilisation of medically trained providers and out-of-pocket payments among ready-made garment workers? A case-control study in Bangladesh
Author(s) Ahmed, Sayem
Sarker, Abdur Razzaque
Sultana, Marufa
Roth, Felix
Mahumud, Rashidul Alam
Kamruzzaman, Md
Hasan, Md Zahid
Mirelman, Andrew J.
Islam, Ziaul
Niessen, Louis W.
Rehnberg, Clas
Khan, AK Azad
Gyr, Niklaus
Khan, Jahangir A.M.
Journal name BMJ Open
Volume number 10
Article ID e030298
Start page 1
End page 12
Total pages 12
Publisher BMJ
Place of publication London, Eng.
Publication date 2020-03
ISSN 2044-6055
2044-6055
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
CARE EXPENDITURE
SAMPLE-SIZES
DETERMINANTS
PROTECTION
COUNTRIES
SERVICES
ACCESS
IMPACT
DRUGS
INDIA
Bangladesh
RMG workers
difference-in-difference
employer sponsored health insurance
medically trained provider
Summary Objective We estimated the effect of an employer-sponsored health insurance (ESHI) scheme on healthcare utilisation of medically trained providers and reduction of out-of-pocket (OOP) expenditure among ready-made garment (RMG) workers.Design We used a case–control study design with cross-sectional preintervention and postintervention surveys.Settings The study was conducted among workers of seven purposively selected RMG factories in Shafipur, Gazipur in Bangladesh.Participants In total, 1924 RMG workers (480 from the insured and 482 from the uninsured, in each period) were surveyed from insured and uninsured RMG factories, respectively, in the preintervention (October 2013) and postintervention (April 2015) period.Interventions We tested the effect of a pilot ESHI scheme which was implemented for 1 year.Outcome measures The outcome measures were utilisation of medically trained providers and reduction of OOP expenditure among RMG workers. We estimated difference-in-difference (DiD) and applied two-part regression model to measure the association between healthcare utilisation, OOP payments and ESHI scheme membership while controlling for the socioeconomic characteristics of workers.Results The ESHI scheme increased healthcare utilisation of medically trained providers by 26.1% (DiD=26.1; p<0.01) among insured workers compared with uninsured workers. While accounting for covariates, the effect on utilisation significantly reduced to 18.4% (p<0.05). The DiD estimate showed that OOP expenditure among insured workers decreased by −3700 Bangladeshi taka and -1100 Bangladeshi taka compared with uninsured workers when using healthcare services from medically trained providers or all provider respectively, although not significant. The multiple two-part models also reported similar results.Conclusion The ESHI scheme significantly increased utilisation of medically trained providers among RMG workers. However, it has no significant effect on OOP expenditure. It can be recommended that an educational intervention be provided to RMG workers to improve their healthcare-seeking behaviours and increase their utilisation of ESHI-designated healthcare providers while keeping OOP payments low.
Language eng
DOI 10.1136/bmjopen-2019-030298
Indigenous content off
Field of Research 1103 Clinical Sciences
1117 Public Health and Health Services
1199 Other Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30145523

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.