Habib Shifa Salman, Zaidi Shehla
Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan.
Department of Community Health Sciences, The Aga Khan University, National Stadium Road, Karachi, Pakistan.
BMC Health Serv Res. 2021 Apr 23;21(1):380. doi: 10.1186/s12913-021-06403-6.
Achieving universal health coverage (UHC) and reduction in out of pocket (OOP) expenditures on health, is a critical target of the Sustainable Development Goals (SDG). In low-middle income countries, micro-health insurance (MHI) schemes have emerged as a useful financing tool for laying grounds for Universal Health Coverage. The aim of this study was to provide evidence for designing a feasible health insurance scheme targeted at urban poor, by exploring preferences for an insurance benefits package and co-payments among women from low-income households in Karachi, Pakistan.
This was a descriptive cross-sectional study, conducted using household surveys between July-August 2015. A total of 167 female beneficiaries of Benazir Income Support Programme (BISP), a large-scale cash transfer scheme targeted at low-income households, were recruited in Karachi through a mix of convenience and snowball sampling. Hypothetical insurance benefits packages for a prospective health insurance scheme were formulated to capture respondents' preferences for health insurance benefits package and co-payments. All data was analyzed using Stata (version 13).
Respondents reporting expenditure on OPD and hospitalization in the last 2 weeks were 93.4 and 11.9% respectively. The highest median expenditure was incurred on medicines. Out of the proposed benefits package, a majority (53%) of the study participants opted for the comprehensive benefits package that provided coverage for emergency care, hospitalization, OPD consultation, diagnostic tests and transportation. For the co-payment plan, 38.9% participants preferred no co-payments that is 100% insurance coverage of medicines followed by hospitalization (25.9%). Nearly half of the respondents (49.4%) chose outpatient consultation for 50% co-payment. A majority of the participants (65.3%) agreed to 100% co-payment for the transportation cost.
Health insurance schemes can be introduced in urban areas, against collection of micro-payments, to prevent low-income households from facing financial catastrophe. A comprehensive benefits package covering emergency care, hospitalization, OPD consultation, diagnostic tests and transportation, is the most preferred among low-income beneficiaries.
实现全民健康覆盖（UHC）并减少医疗自费支出，是可持续发展目标（SDG）的一项关键指标。在中低收入国家，小额健康保险（MHI）计划已成为为全民健康覆盖奠定基础的一种有用融资工具。本研究的目的是通过探究巴基斯坦卡拉奇低收入家庭女性对保险福利套餐和共付额的偏好，为设计一项针对城市贫困人口的可行健康保险计划提供依据。
这是一项描述性横断面研究，于2015年7月至8月期间通过家庭调查开展。通过便利抽样和滚雪球抽样相结合的方式，在卡拉奇招募了167名贝娜齐尔收入支持计划（BISP）的女性受益人，该计划是一项针对低收入家庭的大规模现金转移计划。针对一项未来健康保险计划制定了假设性保险福利套餐，以了解受访者对健康保险福利套餐和共付额的偏好。所有数据均使用Stata（版本13）进行分析。
在过去两周内报告有门诊和住院支出的受访者分别为93.4%和11.9%。药品支出的中位数最高。在提议的福利套餐中，大多数（53%）研究参与者选择了综合福利套餐，该套餐提供急诊、住院、门诊咨询、诊断检查和交通费用的保险。对于共付计划，38.9%的参与者倾向于不设共付额，即药品100%保险覆盖，其次是住院（25.9%）。近一半的受访者（49.4%）选择门诊咨询共付50%。大多数参与者（65.3%）同意交通费用100%共付。
可以在城市地区推出健康保险计划，收取小额费用，以防止低收入家庭面临经济灾难。涵盖急诊、住院、门诊咨询、诊断检查和交通费用的综合福利套餐，是低收入受益人中最受欢迎的。
