The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh.

Autor: Khan JAM; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom.; Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.; Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18a, 171 65 Solna, Sweden., Ahmed S; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom.; Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.; Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18a, 171 65 Solna, Sweden., Sultana M; Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.; Deakin Health Economics, School of Health and Social Development, Deakin University, 221 Burwood Highway Burwood VIC 3125 Melbourne, Australia., Sarker AR; Health Economics and Financing Research, Population Studies Division, Bangladesh Institute of Development Studies (BIDS), E-17, Shahid Shahabuddin Shorok, Agargaon, Dhaka 1207, Bangladesh., Chakrovorty S; Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.; Department of Agricultural Economics, Purdue University, Room # 631, Krannert Building, 403 West State Street, West Lafayette, Indiana 47906, USA., Rahman MH; Health Economics Unit, Ministry of Health and Family Welfare, 14/2 Topkhana Road (3rd-4th Floor), Dhaka 1000, Bangladesh., Islam Z; Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh., Rehnberg C; Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18a, 171 65 Solna, Sweden., Niessen LW; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom.
Jazyk: angličtina
Zdroj: International health [Int Health] 2020 Jul 01; Vol. 12 (4), pp. 287-298.
DOI: 10.1093/inthealth/ihz083
Abstrakt: Background: We 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.
Methods: A 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.
Results: The 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.
Conclusions: The 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.
(© The Author(s) 2019. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)
Databáze: MEDLINE
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