Please use this identifier to cite or link to this item:
http://bura.brunel.ac.uk/handle/2438/30470
Title: | Adverse selection in community based health insurance among informal workers in Bangladesh: An EQ-5D assessment |
Authors: | Ahmed, S Sarker, AR Sultana, M Chakrovorty, S Hasan, MZ Mirelman, AJ Khan, JAM |
Keywords: | adverse selection;community based health insurance;EQ-5D |
Issue Date: | 31-Jan-2018 |
Publisher: | MDPI |
Citation: | Ahmed, S. et al. (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, pp. 1 - 10. doi: 10.3390/ijerph15020242. |
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. |
URI: | https://bura.brunel.ac.uk/handle/2438/30470 |
DOI: | https://doi.org/10.3390/ijerph15020242 |
ISSN: | 1661-7827 |
Other Identifiers: | ORCiD: Sayem Ahmed https://orcid.org/0000-0001-9499-1500 ORCiD: Md. Zahid Hasan https://orcid.org/0000-0002-3824-8947 ORCiD: Andrew J. Mirelman https://orcid.org/0000-0002-7622-0937 242 |
Appears in Collections: | Dept of Health Sciences Research Papers |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
FullText.pdf | Copyright © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). | 632.76 kB | Adobe PDF | View/Open |
This item is licensed under a Creative Commons License