Adverse Selection in Community Based Health Insurance among Informal Workers in Bangladesh: An EQ-5D Assessment
Abstract
:1. Introduction
2. Materials and Methods
2.1. CBHI Scheme
2.2. Study Design
2.3. Study Population and Sample
2.4. Data Collection
2.5. Health Status Measurement
2.6. Econometric Analysis
3. Results
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Services | Co-Payment/Description * |
---|---|
Health benefits | |
General practitioner (GP) Consultation | 30 BDT (Market price = 300 BDT) |
Medicine | 20% discount from maximum retail price |
Diagnostic tests | 50% discount on market price |
Specialist doctor consultation | 100 BDT (Market price = 500 BDT) |
Hospitalization | Maximum 4000 BDT per household per year |
Periodic satellite clinics in remote rural areas | Free of charge |
Non-health benefits | |
Savings opportunity |
|
Training programs |
|
Characteristics | Insured (N = 646) | Uninsured (N = 646) | p-Value |
---|---|---|---|
% (95% CI) | % (95% CI) | ||
Age group | |||
Adult (<60) | 95.8 (93.9–97.1) | 95.5 (93.6–96.9) | 0.780 a |
Elderly (60+) | 4.3 (2.9–6.0) | 4.5 (3.1–6.4) | |
Gender | |||
Female | 51.7 (47.8–55.5) | 56.0 (52.2–59.8) | 0.120 a |
Male | 48.3 (44.5–52.2) | 44.0 (40.2–47.8) | |
Household size | |||
Fewer than 4 members | 6.8 (5.1–9.0) | 15.8 (13.2–18.8) | 0.001 b |
4–5 members | 40.6 (36.8–44.4) | 53.9 (50.0–57.7) | |
6 members or more | 52.6 (48.8–56.5) | 30.3 (26.9–34.0) |
Characteristics | Insured | Uninsured | p-Value |
---|---|---|---|
% (95% CI) | % (95% CI) | ||
EQ-5D mean score | 0.704 (0.682–0.727) | 0.749 (0.730–0.769) | 0.003 |
EQ-5D median score | 0.726 | 0.766 | |
VAS (mean score) | 77.0 (75.5–78.5) | 77.3 (75.9–78.7) | 0.783 |
VAS (Median score) | 80.0 | 80.0 | |
Self-reported chronic illness/symptoms | 9.8 (7.5–12.0) | 7.6 (5.5–9.6) | 0.166 |
Variables | Description | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 |
---|---|---|---|---|---|---|
Age group | Elderly, 60+ (Ref = Adult, <60) | 0.810 (0.455–1.440) | 0.891 (0.504–1.575) | 0.910 (0.516–1.603) | 0.887 (0.503–1.563) | 0.980 (0.555–1.728) |
Gender | Female (Ref = Male) | 1.217 (0.965–1.534) | 1.247 (0.989–1.574) | 1.172 (0.931–1.476) | 1.188 (0.944–1.495) | 1.123 (0.893–1.411) |
Household size | 4–5 members (Ref = Fewer than 4 members) | 1.747 ** (1.180–2.585) | 1.793 ** (1.207–2.662) | 1.730 ** (1.171–2.557) | 1.713 ** (1.158–2.532) | 1.719 ** (1.164–2.539) |
6 members or more (Ref = Fewer than 4 members) | 4.034 *** (2.705–6.016) | 4.272 *** (2.853–6.398) | 3.982 *** (2.675–5.927) | 3.957 *** (2.657–5.893) | 3.913 *** (2.631–5.820) | |
Chronic illness | Yes (Ref = No) | 1.218 (0.808–1.834) | 1.252 (0.831–1.887) | 1.231 (0.817–1.856) | 1.178 (0.781–1.777) | 1.332 (0.886–2.001) |
Mobility | Any problem (Ref = No problem) | 1.649 *** (1.253–2.170) | - | - | - | - |
Self-care | Any problem (Ref = No problem) | - | 2.290 *** (1.617–3.245) | - | - | - |
Usual activities | Any problem (Ref = No problem) | - | - | 1.244 (0.960–1.613) | - | - |
Pain and discomfort | Any problem (Ref = No problem) | - | - | - | 1.431 ** (1.133–1.807) | - |
Anxiety or depression | Any problem (Ref = No problem) | - | - | - | - | 0.878 (0.698–1.103) |
Constant | 0.347 *** (0.236–0.509) | 0.331 *** (0.225–0.487) | 0.375 *** (0.256–0.550) | 0.343 *** (0.232–0.505) | 0.436 *** (0.295–0.646) | |
N | 1291 | 1291 | 1291 | 1291 | 1291 | |
LR chi2(27) | 90.12 | 99.84 | 79.94 | 86.32 | 78.45 | |
Prob. > chi2 | 0.000 | 0.000 | 0.000 | 0.000 | 0.000 | |
Pseudo R2 | 0.050 | 0.056 | 0.045 | 0.048 | 0.044 |
Variables | Description | Model 6 (Dependent = CBHI Enrollment; 1 = Insured, 0 = Uninsured) Odds Ratio (95% CI) |
---|---|---|
Age group | Elderly, 60+ (Ref = Adult, <60) | 0.861 (0.488–1.518) |
Gender | Female (Ref = Male) | 1.196 (0.950–1.506) |
Household size | 4–5 members (Ref ≤ 4 members) | 1.736 ** (1.173–2.570) |
≥6 members (Ref ≤ 4 members) | 4.049 *** (2.715–6.040) | |
Chronic illness | Yes (Ref = No) | 1.164 (0.771–1.757) |
Eq-5D score | 0.460 *** (0.307–0.689) | |
Constant | 0.711 (0.444–1.137) | |
N | 1291 | |
LR chi2(27) | −848.9 | |
Prob. > chi2 | 0.000 | |
Pseudo R2 | 0.051 |
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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. https://doi.org/10.3390/ijerph15020242
Ahmed S, Sarker AR, Sultana M, Chakrovorty S, Hasan MZ, Mirelman AJ, Khan JAM. Adverse Selection in Community Based Health Insurance among Informal Workers in Bangladesh: An EQ-5D Assessment. International Journal of Environmental Research and Public Health. 2018; 15(2):242. https://doi.org/10.3390/ijerph15020242
Chicago/Turabian StyleAhmed, Sayem, Abdur Razzaque Sarker, Marufa Sultana, Sanchita Chakrovorty, Md. Zahid Hasan, Andrew J. Mirelman, and Jahangir A. M. Khan. 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 15, no. 2: 242. https://doi.org/10.3390/ijerph15020242
APA StyleAhmed, S., Sarker, A. R., Sultana, M., Chakrovorty, S., Hasan, M. Z., Mirelman, A. J., & Khan, J. A. M. (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, 15(2), 242. https://doi.org/10.3390/ijerph15020242