Adverse selection in community based health insurance among informal workers in Bangladesh: an EQ-5D assessment

Ahmed, S. , Sarker, A. R., Sultana, M., Chakrovorty, S., Hasan, M. Z., Mirelman, A. J. and 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. (doi: 10.3390/ijerph15020242) (PMID:29385072) (PMCID:PMC5858311)

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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:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Ahmed, Dr Sayem
Authors: Ahmed, S., Sarker, A. R., Sultana, M., Chakrovorty, S., Hasan, M. Z., Mirelman, A. J., and Khan, J. A.M.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
Journal Name:International Journal of Environmental Research and Public Health
Publisher:MDPI
ISSN:1661-7827
ISSN (Online):1660-4601
Published Online:31 January 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in International Journal of Environmental Research and Public Health 15(2): 242
Publisher Policy:Reproduced under a Creative Commons License

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