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Willingness-to-Pay for Community-Based Health Insurance among Informal Workers in Urban Bangladesh

INTRODUCTION: Reliance on out-of-pocket payment for healthcare may lead poor households to undertake catastrophic health expenditure, and risk-pooling mechanisms have been recommended to mitigate such burdens for households in Bangladesh. About 88% of the population of Bangladesh depends on work in...

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Autores principales: Ahmed, Sayem, Hoque, Mohammad Enamul, Sarker, Abdur Razzaque, Sultana, Marufa, Islam, Ziaul, Gazi, Rukhsana, Khan, Jahangir A. M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734618/
https://www.ncbi.nlm.nih.gov/pubmed/26828935
http://dx.doi.org/10.1371/journal.pone.0148211
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author Ahmed, Sayem
Hoque, Mohammad Enamul
Sarker, Abdur Razzaque
Sultana, Marufa
Islam, Ziaul
Gazi, Rukhsana
Khan, Jahangir A. M.
author_facet Ahmed, Sayem
Hoque, Mohammad Enamul
Sarker, Abdur Razzaque
Sultana, Marufa
Islam, Ziaul
Gazi, Rukhsana
Khan, Jahangir A. M.
author_sort Ahmed, Sayem
collection PubMed
description INTRODUCTION: Reliance on out-of-pocket payment for healthcare may lead poor households to undertake catastrophic health expenditure, and risk-pooling mechanisms have been recommended to mitigate such burdens for households in Bangladesh. About 88% of the population of Bangladesh depends on work in the informal sector. We aimed to estimate willingness-to-pay (WTP) for CBHI and identify its determinants among three categories of urban informal workers rickshaw-pullers, shopkeepers and restaurant workers. METHODS: The bidding game version of contingent valuation method was used to estimate weekly WTP. In three urban locations 557 workers were interviewed using a structured questionnaire during 2010 and 2011. Multiple-regression analysis was used to predict WTP by demographic and household characteristics, occupation, education level and past illness. RESULTS: WTP for a CBHI scheme was expressed by 86.7% of informal workers. Weekly average WTP was 22.8 BDT [Bangladeshi Taka; 95% confidence interval (CI) 20.9–24.8] or 0.32 USD and varied significantly across occupational groups (p = 0.000) and locations (p = 0.003). WTP was highest among rickshaw-pullers (28.2 BDT or 0.40 USD; 95% CI: 24.7–31.7), followed by restaurant workers (20.4 BDT 0.29 USD; 95% CI: 17.0–23.8) and shopkeepers (19.2 BDT or 0.27 USD; 95% CI: 16.1–22.4). Multiple regression analysis identified monthly income, occupation, geographical location and educational level as the key determinants of WTP. WTP increased 0.196% with each 1% increase in monthly income, and was 26.9% lower among workers with up to a primary level of education versus those with higher than primary, but less than one year of education. CONCLUSION: Informal workers in urban areas thus are willing to pay for CBHI and socioeconomic differences explain the magnitude of WTP. The policy maker might think introducing community-based model including public-community partnership model for healthcare financing of informal workers. Decision making regarding the implementation of such schemes should consider worker location and occupation.
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spelling pubmed-47346182016-02-04 Willingness-to-Pay for Community-Based Health Insurance among Informal Workers in Urban Bangladesh Ahmed, Sayem Hoque, Mohammad Enamul Sarker, Abdur Razzaque Sultana, Marufa Islam, Ziaul Gazi, Rukhsana Khan, Jahangir A. M. PLoS One Research Article INTRODUCTION: Reliance on out-of-pocket payment for healthcare may lead poor households to undertake catastrophic health expenditure, and risk-pooling mechanisms have been recommended to mitigate such burdens for households in Bangladesh. About 88% of the population of Bangladesh depends on work in the informal sector. We aimed to estimate willingness-to-pay (WTP) for CBHI and identify its determinants among three categories of urban informal workers rickshaw-pullers, shopkeepers and restaurant workers. METHODS: The bidding game version of contingent valuation method was used to estimate weekly WTP. In three urban locations 557 workers were interviewed using a structured questionnaire during 2010 and 2011. Multiple-regression analysis was used to predict WTP by demographic and household characteristics, occupation, education level and past illness. RESULTS: WTP for a CBHI scheme was expressed by 86.7% of informal workers. Weekly average WTP was 22.8 BDT [Bangladeshi Taka; 95% confidence interval (CI) 20.9–24.8] or 0.32 USD and varied significantly across occupational groups (p = 0.000) and locations (p = 0.003). WTP was highest among rickshaw-pullers (28.2 BDT or 0.40 USD; 95% CI: 24.7–31.7), followed by restaurant workers (20.4 BDT 0.29 USD; 95% CI: 17.0–23.8) and shopkeepers (19.2 BDT or 0.27 USD; 95% CI: 16.1–22.4). Multiple regression analysis identified monthly income, occupation, geographical location and educational level as the key determinants of WTP. WTP increased 0.196% with each 1% increase in monthly income, and was 26.9% lower among workers with up to a primary level of education versus those with higher than primary, but less than one year of education. CONCLUSION: Informal workers in urban areas thus are willing to pay for CBHI and socioeconomic differences explain the magnitude of WTP. The policy maker might think introducing community-based model including public-community partnership model for healthcare financing of informal workers. Decision making regarding the implementation of such schemes should consider worker location and occupation. Public Library of Science 2016-02-01 /pmc/articles/PMC4734618/ /pubmed/26828935 http://dx.doi.org/10.1371/journal.pone.0148211 Text en © 2016 Ahmed et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Ahmed, Sayem
Hoque, Mohammad Enamul
Sarker, Abdur Razzaque
Sultana, Marufa
Islam, Ziaul
Gazi, Rukhsana
Khan, Jahangir A. M.
Willingness-to-Pay for Community-Based Health Insurance among Informal Workers in Urban Bangladesh
title Willingness-to-Pay for Community-Based Health Insurance among Informal Workers in Urban Bangladesh
title_full Willingness-to-Pay for Community-Based Health Insurance among Informal Workers in Urban Bangladesh
title_fullStr Willingness-to-Pay for Community-Based Health Insurance among Informal Workers in Urban Bangladesh
title_full_unstemmed Willingness-to-Pay for Community-Based Health Insurance among Informal Workers in Urban Bangladesh
title_short Willingness-to-Pay for Community-Based Health Insurance among Informal Workers in Urban Bangladesh
title_sort willingness-to-pay for community-based health insurance among informal workers in urban bangladesh
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734618/
https://www.ncbi.nlm.nih.gov/pubmed/26828935
http://dx.doi.org/10.1371/journal.pone.0148211
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