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

Ahmed, S, Sarker, AR, Sultana, M, Chakrovorty, S, Hasan, MZ, Mirelman, AJ and Khan, JAM 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, vol. 15, no. 2, pp. 1-13, doi: 10.3390/ijerph15020242.

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Title Adverse selection in community based health insurance among informal workers in Bangladesh: An EQ-5D assessment
Author(s) Ahmed, S
Sarker, AR
Sultana, M
Chakrovorty, S
Hasan, MZ
Mirelman, AJ
Khan, JAM
Journal name International Journal of Environmental Research and Public Health
Volume number 15
Issue number 2
Article ID 242
Start page 1
End page 13
Total pages 13
Publisher MDPI
Place of publication Basel, Switzerland
Publication date 2018-01-31
ISSN 1661-7827
1660-4601
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Environmental Sciences
Public, Environmental & Occupational Health
Environmental Sciences & Ecology
adverse selection
community based health insurance
EQ-5D
CARE
SCHEME
Summary 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.
Language eng
DOI 10.3390/ijerph15020242
Indigenous content off
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2018, The Author(s)
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30145542

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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.