Health Economics and Financing Research Group, Health Systems and Population Studies Division, Bangladesh (icddr,b), Dhaka 1212, Bangladesh.
Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Int J Environ Res Public Health. 2018 Jan 31;15(2):242. doi: 10.3390/ijerph15020242.
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%; = 0.002); self-care (7.1%; = 0.000) and pain and discomfort (7.7%; = 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.
社区健康保险（CBHI）计划被推荐为孟加拉国低收入非正规工人提供财务风险保护。我们评估了在这种情况下试点 CBHI 计划中的逆向选择问题。总共调查了 1292 名（646 名参保和 646 名未参保）受访者，使用孟加拉语版 EuroQuol-5 维度（EQ-5D）问卷评估他们的健康状况。使用可用的区域关税估算 EQ-5D 分数。应用多变量逻辑回归预测健康状况与 CBHI 计划参保之间的关联。更多的参保者报告在移动性（7.3%； = 0.002）；自我护理（7.1%； = 0.000）和疼痛不适（7.7%； = 0.005）方面存在问题。参保者的平均 EQ-5D 评分明显低于未参保者（0.704 对 0.749）。回归分析表明，那些在移动性方面有问题的人（m 1.25-2.17）；自我护理（OR = 2.29；95%CI：1.62-3.25）和疼痛不适（OR = 1.43；95%CI：1.13-1.81）更有可能加入该计划。EQ-5D 得分较高的人（OR = 0.46；95%CI：0.31-0.69）不太可能加入该计划。鉴于试点 CBHI 计划中存在逆向选择，在规划这些计划的扩大规模时应考虑到这一问题。
