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The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh

Khan, Jahangir ORCID:, Ahmed, Sayem ORCID:, Sultana, Marufa, Sarker, Abdur Razzaque, Chakrovorty, Sanchita, Rahman, Mohammad Hafizur, Islam, Ziaul, Rehnberg, Clas and Niessen, Louis ORCID: (2020) 'The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh'. International Health, Vol 12, Issue 4, pp. 287-298.

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We aimed to estimate the effect of the community-based health insurance (CBHI) scheme on the magnitude of out-of-pocket (OOP) payments for the healthcare of the informal workers and their dependents. The CBHI scheme was piloted through a cooperative of informal workers, which covered seven unions in Chandpur Sadar Upazila, Bangladesh.
A quasi-experimental study was conducted using a case-comparison design. In total 1292 (646 insured and 646 uninsured) households were surveyed. Propensity score matching was done to minimize the observed baseline differences in the characteristics between the insured and uninsured groups. A two-part regression model was applied using both the probability of OOP spending and magnitude of such spending for healthcare in assessing the association with enrolment status in the CBHI scheme while controlling for other covariates.

The OOP payment was 6.4% (p < 0.001) lower for medically trained provider (MTP) utilization among the insured compared with the uninsured. However, no significant difference was found in the OOP payments for healthcare utilization from all kind of providers, including the non-trained ones.
The CBHI scheme could reduce OOP payments while providing better quality healthcare through the increased use of MTPs, which consequently could push the country towards universal health coverage.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 74 Medical economics. Health care costs
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
Faculty: Department: Biological Sciences > Department of Tropical Disease Biology
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Stacy Murtagh
Date Deposited: 04 Dec 2019 12:07
Last Modified: 30 Nov 2020 02:02


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