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

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 sev...

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Autores principales: Khan, Jahangir A M, Ahmed, Sayem, Sultana, Marufa, Sarker, Abdur Razzaque, Chakrovorty, Sanchita, Rahman, Mohammad Hafizur, Islam, Ziaul, Rehnberg, Clas, Niessen, Louis W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322207/
https://www.ncbi.nlm.nih.gov/pubmed/31782795
http://dx.doi.org/10.1093/inthealth/ihz083
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author Khan, Jahangir A M
Ahmed, Sayem
Sultana, Marufa
Sarker, Abdur Razzaque
Chakrovorty, Sanchita
Rahman, Mohammad Hafizur
Islam, Ziaul
Rehnberg, Clas
Niessen, Louis W
author_facet Khan, Jahangir A M
Ahmed, Sayem
Sultana, Marufa
Sarker, Abdur Razzaque
Chakrovorty, Sanchita
Rahman, Mohammad Hafizur
Islam, Ziaul
Rehnberg, Clas
Niessen, Louis W
author_sort Khan, Jahangir A M
collection PubMed
description 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.
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spelling pubmed-73222072020-07-02 The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh Khan, Jahangir A M Ahmed, Sayem Sultana, Marufa Sarker, Abdur Razzaque Chakrovorty, Sanchita Rahman, Mohammad Hafizur Islam, Ziaul Rehnberg, Clas Niessen, Louis W Int Health Original Article 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. Oxford University Press 2019-11-29 /pmc/articles/PMC7322207/ /pubmed/31782795 http://dx.doi.org/10.1093/inthealth/ihz083 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Khan, Jahangir A M
Ahmed, Sayem
Sultana, Marufa
Sarker, Abdur Razzaque
Chakrovorty, Sanchita
Rahman, Mohammad Hafizur
Islam, Ziaul
Rehnberg, Clas
Niessen, Louis W
The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh
title The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh
title_full The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh
title_fullStr The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh
title_full_unstemmed The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh
title_short The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh
title_sort effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in bangladesh
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322207/
https://www.ncbi.nlm.nih.gov/pubmed/31782795
http://dx.doi.org/10.1093/inthealth/ihz083
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