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Int. J. Environ. Res. Public Health 2018, 15(2), 242; https://doi.org/10.3390/ijerph15020242

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

1
Health Economics and Financing Research Group, Health Systems and Population Studies Division, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
2
Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, SE-171 77 Stockholm, Sweden
3
Department of Management Science, University of Strathclyde, Glasgow G1 1XQ, UK
4
Faculty of Health, Deakin University, Melbourne, VIC 3125, Australia
5
Department of Agriculture Economics, Purdue University, IN 47907, USA
6
Centre for Health Economics, University of York, York YO10 5DD, UK
7
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
*
Author to whom correspondence should be addressed.
Received: 15 November 2017 / Revised: 4 January 2018 / Accepted: 29 January 2018 / Published: 31 January 2018
(This article belongs to the Special Issue Insurance and Health)
Full-Text   |   PDF [633 KB, uploaded 31 January 2018]   |  

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. View Full-Text
Keywords: adverse selection; community based health insurance; EQ-5D adverse selection; community based health insurance; EQ-5D
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Ahmed, S.; Sarker, A.R.; Sultana, M.; Chakrovorty, S.; Hasan, M.Z.; Mirelman, A.J.; Khan, J.A.M. Adverse Selection in Community Based Health Insurance among Informal Workers in Bangladesh: An EQ-5D Assessment. Int. J. Environ. Res. Public Health 2018, 15, 242.

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