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Adverse Selection in Community Based Health Insurance among Informal Workers in Bangladesh: An EQ-5D Assessment.

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Ahmed, Sayem, Sarker, Abdur Razzaque, Sultana, Marufa, Chakrovorty, Sanchita, Hasan, Md Zahid, Mirelman, Andrew J and Khan, Jahangir (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, Issue 2.

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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.

Item Type: Article
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > WA 20.5 Research (General)
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Health Administration and Organization > WA 525 General works
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.3390/ijerph15020242.
Depositing User: Stacy Murtagh
Date Deposited: 05 Feb 2018 17:35
Last Modified: 05 Feb 2018 17:35
URI: http://archive.lstmed.ac.uk/id/eprint/8196

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