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Ahmed, Sayem 
ORCID: https://orcid.org/0000-0001-9499-1500, Hasan, Md. Zahid, Ali, Nausad, Ahmed, Mohammad Wahid, Haq, Emranul, Shabnam, Sadia, Chowdhury, Morseda, Gahan, Breda, Bousquet, Christine, Khan, Jahangir ORCID: https://orcid.org/0000-0002-6151-764X and Islam, Ziaul
(2021)
'Effectiveness of health voucher scheme and micro-health insurance scheme to support the poor and extreme poor in selected urban areas of Bangladesh: An assessment using a mixed-method approach'. PLoS ONE, Vol 16, Issue 11, e0256067.
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Abstract
Background
National healthcare financing strategy recommends tax-based equity funds and insurance schemes for the poor and extreme poor living in urban slums and pavements as the majority of these population utilise informal providers resulting in adverse health effects and financial hardship. We assessed the effect of a health voucher scheme (HVS) and micro-health insurance (MHI) scheme on healthcare utilisation and out-of-pocket (OOP) payments and the cost of implementing such schemes.
Methods
HVS and MHI schemes were implemented by Concern Worldwide through selected NGO health centres, referral hospitals, and private healthcare facilities in three City Corporations of Bangladesh from December 2016 to March 2020. A household survey with 1,294 enrolees, key-informant interviews, focus group discussions, consultative meetings, and document reviews were conducted for extracting data on healthcare utilisation, OOP payments, views of enrolees, and suggestions of implementers, and costs of services at the point of care.
Results
Healthcare utilisation including maternal, neonatal and child health (MNCH) services, particularly from medically trained providers, was higher and OOP payments were lower among the scheme enrolees compared to corresponding population groups in general. The beneficiaries were happy with their access to healthcare, especially for MNCH services, and their perceived quality of care was fair enough. They, however, suggested expanding the benefits package, supported by an additional workforce. The cost per beneficiary household for providing services per year was €32 in HVS and €15 in MHI scheme.
Conclusion
HVS and MHI schemes enabled higher healthcare utilisation at lower OOP payments among the enrolees, who were happy with their access to healthcare, particularly for MNCH services. However, they suggested a larger benefits package in future. The provider’s costs of the schemes were reasonable; however, there are potentials of cost containment by purchasing the health services for their beneficiaries in a competitive basis from the market. Scaling up such schemes addressing the drawback would contribute to achieving universal health coverage.
| Item Type: | Article |
|---|---|
| Subjects: | W General Medicine. Health Professions > W 74 Medical economics. Health care costs 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 > Clinical Sciences Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1371/journal.pone.0256067 |
| Depositing User: | Stacy Murtagh |
| Date Deposited: | 16 Nov 2021 13:55 |
| Last Modified: | 16 Nov 2021 13:55 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/19447 |
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