TY - JOUR
T1 - The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh
AU - Khan, Jahangir A.M.
AU - Ahmed, Sayem
AU - Sultana, Marufa
AU - Sarker, Abdur Razzaque
AU - Chakrovorty, Sanchita
AU - Rahman, Mohammad Hafizur
AU - Islam, Ziaul
AU - Rehnberg, Clas
AU - Niessen, Louis
PY - 2020/7/1
Y1 - 2020/7/1
N2 - BackgroundWe aimed to estimate the effect of the community-based health insurance (CBHI) scheme on the magnitude of out-of-pocket (OOP) payments for the healthcare of the informal workers and their dependents. The CBHI scheme was piloted through a cooperative of informal workers, which covered seven unions in Chandpur Sadar Upazila, Bangladesh.MethodsA quasi-experimental study was conducted using a case-comparison design. In total 1292 (646 insured and 646 uninsured) households were surveyed. Propensity score matching was done to minimize the observed baseline differences in the characteristics between the insured and uninsured groups. A two-part regression model was applied using both the probability of OOP spending and magnitude of such spending for healthcare in assessing the association with enrolment status in the CBHI scheme while controlling for other covariates.ResultsThe OOP payment was 6.4% (p < 0.001) lower for medically trained provider (MTP) utilization among the insured compared with the uninsured. However, no significant difference was found in the OOP payments for healthcare utilization from all kind of providers, including the non-trained ones.ConclusionsThe CBHI scheme could reduce OOP payments while providing better quality healthcare through the increased use of MTPs, which consequently could push the country towards universal health coverage.
AB - BackgroundWe aimed to estimate the effect of the community-based health insurance (CBHI) scheme on the magnitude of out-of-pocket (OOP) payments for the healthcare of the informal workers and their dependents. The CBHI scheme was piloted through a cooperative of informal workers, which covered seven unions in Chandpur Sadar Upazila, Bangladesh.MethodsA quasi-experimental study was conducted using a case-comparison design. In total 1292 (646 insured and 646 uninsured) households were surveyed. Propensity score matching was done to minimize the observed baseline differences in the characteristics between the insured and uninsured groups. A two-part regression model was applied using both the probability of OOP spending and magnitude of such spending for healthcare in assessing the association with enrolment status in the CBHI scheme while controlling for other covariates.ResultsThe OOP payment was 6.4% (p < 0.001) lower for medically trained provider (MTP) utilization among the insured compared with the uninsured. However, no significant difference was found in the OOP payments for healthcare utilization from all kind of providers, including the non-trained ones.ConclusionsThe CBHI scheme could reduce OOP payments while providing better quality healthcare through the increased use of MTPs, which consequently could push the country towards universal health coverage.
KW - Bangladesh
KW - Community-based health insurance
KW - Healthcare financing
KW - Informal workers
KW - Out-of-pocket payments
U2 - 10.1093/inthealth/ihz083
DO - 10.1093/inthealth/ihz083
M3 - Article
SN - 1876-3413
VL - 12
SP - 287
EP - 298
JO - International Health
JF - International Health
IS - 4
ER -