IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v15y2018i2p242-d129594.html
   My bibliography  Save this article

Adverse Selection in Community Based Health Insurance among Informal Workers in Bangladesh: An EQ-5D Assessment

Author

Listed:
  • Sayem Ahmed

    (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)

  • Abdur Razzaque Sarker

    (Health Economics and Financing Research Group, Health Systems and Population Studies Division, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
    Department of Management Science, University of Strathclyde, Glasgow G1 1XQ, UK)

  • Marufa Sultana

    (Health Economics and Financing Research Group, Health Systems and Population Studies Division, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
    Faculty of Health, Deakin University, Melbourne, VIC 3125, Australia)

  • Sanchita Chakrovorty

    (Health Economics and Financing Research Group, Health Systems and Population Studies Division, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
    Department of Agriculture Economics, Purdue University, IN 47907, USA)

  • Md. Zahid Hasan

    (Health Economics and Financing Research Group, Health Systems and Population Studies Division, Bangladesh (icddr,b), Dhaka 1212, Bangladesh)

  • Andrew J. Mirelman

    (Centre for Health Economics, University of York, York YO10 5DD, UK)

  • Jahangir A. M. Khan

    (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
    Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK)

Abstract

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%; p = 0.002); self-care (7.1%; p = 0.000) and pain and discomfort (7.7%; p = 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.

Suggested Citation

  • Sayem Ahmed & Abdur Razzaque Sarker & Marufa Sultana & Sanchita Chakrovorty & Md. Zahid Hasan & Andrew J. Mirelman & Jahangir A. M. Khan, 2018. "Adverse Selection in Community Based Health Insurance among Informal Workers in Bangladesh: An EQ-5D Assessment," IJERPH, MDPI, vol. 15(2), pages 1-10, January.
    • Handle: RePEc:gam:jijerp:v:15:y:2018:i:2:p:242-:d:129594
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/15/2/242/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/15/2/242/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Wang, Hong & Zhang, Licheng & Yip, Winnie & Hsiao, William, 2006. "Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China," Social Science & Medicine, Elsevier, vol. 63(5), pages 1236-1245, September.
    2. Hermann Donfouet & Pierre-Alexandre Mahieu, 2012. "Community-based health insurance and social capital: a review," Health Economics Review, Springer, vol. 2(1), pages 1-5, December.
    3. Cutler, David M. & Zeckhauser, Richard J., 2000. "The anatomy of health insurance," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 11, pages 563-643, Elsevier.
    4. Marcelo Resende & Rodrigo Zeidan, 2010. "Adverse selection in the health insurance market: some empirical evidence," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(4), pages 413-418, August.
    5. Michael Rothschild & Joseph Stiglitz, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 90(4), pages 629-649.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Kuniyoshi Toyoshima & Takeshi Inoue & Toshiaki Baba & Jiro Masuya & Masahiko Ichiki & Yota Fujimura & Ichiro Kusumi, 2021. "Associations of Cognitive Complaints and Depressive Symptoms with Health-Related Quality of Life and Perceived Overall Health in Japanese Adult Volunteers," IJERPH, MDPI, vol. 18(18), pages 1-12, September.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Liran Einav & Amy Finkelstein & Maria Polyakova, 2018. "Private Provision of Social Insurance: Drug-Specific Price Elasticities and Cost Sharing in Medicare Part D," American Economic Journal: Economic Policy, American Economic Association, vol. 10(3), pages 122-153, August.
    2. Boone, Jan, 2015. "Basic versus supplementary health insurance: Moral hazard and adverse selection," Journal of Public Economics, Elsevier, vol. 128(C), pages 50-58.
    3. Liran Einav & Amy Finkelstein & Mark R. Cullen, 2010. "Estimating Welfare in Insurance Markets Using Variation in Prices," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(3), pages 877-921.
    4. Daniel McFadden & Carlos Noton & Pau Olivella, "undated". "Remedies for Sick Insurance," Working Papers 620, Barcelona School of Economics.
    5. Keane, Michael, 2004. "Modeling Health Insurance Choices in “Competitive” Markets," MPRA Paper 55198, University Library of Munich, Germany.
    6. K. P. M. Winssen & R. C. Kleef & W. P. M. M. Ven, 2017. "A voluntary deductible in health insurance: the more years you opt for it, the lower your premium?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(2), pages 209-226, March.
    7. Jacob Glazer & Thomas G. McGuire, 2006. "Contending with Risk Selection in Health Insurance Markets in Germany," Perspektiven der Wirtschaftspolitik, Verein für Socialpolitik, vol. 7(s1), pages 75-91, May.
    8. David M. Cutler & Amy Finkelstein & Kathleen McGarry, 2008. "Preference Heterogeneity and Insurance Markets: Explaining a Puzzle of Insurance," American Economic Review, American Economic Association, vol. 98(2), pages 157-162, May.
    9. Timothy J. Layton & Randall P. Ellis & Thomas G. McGuire, 2015. "Assessing Incentives for Adverse Selection in Health Plan Payment Systems," NBER Working Papers 21531, National Bureau of Economic Research, Inc.
    10. McGuire, Thomas G. & Newhouse, Joseph P. & Normand, Sharon-Lise & Shi, Julie & Zuvekas, Samuel, 2014. "Assessing incentives for service-level selection in private health insurance exchanges," Journal of Health Economics, Elsevier, vol. 35(C), pages 47-63.
    11. Matthew Panhans, 2019. "Adverse Selection in ACA Exchange Markets: Evidence from Colorado," American Economic Journal: Applied Economics, American Economic Association, vol. 11(2), pages 1-36, April.
    12. Marcus C. Christiansen & Martin Eling & Jan-Philipp Schmidt & Lorenz Zirkelbach, 2016. "Who is Changing Health Insurance Coverage? Empirical Evidence on Policyholder Dynamics," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 83(2), pages 269-300, June.
    13. Amelie C. Wuppermann, 2017. "Private Information in Life Insurance, Annuity, and Health Insurance Markets," Scandinavian Journal of Economics, Wiley Blackwell, vol. 119(4), pages 855-881, October.
    14. Patricia H. Born & E. Tice Sirmans, 2020. "Restrictive Rating and Adverse Selection in Health Insurance," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 87(4), pages 919-933, December.
    15. Frank, Richard G. & Glazer, Jacob & McGuire, Thomas G., 2000. "Measuring adverse selection in managed health care," Journal of Health Economics, Elsevier, vol. 19(6), pages 829-854, November.
    16. Rudy Douven, 2000. "Regulated competition in health insurance markets," CPB Research Memorandum 171.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    17. Andrey Aistov & Ekaterina Aleksandrova & Christopher J. Gerry, 2021. "Voluntary private health insurance, health-related behaviours and health outcomes: evidence from Russia," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(2), pages 281-309, March.
    18. repec:mea:meawpa:12260 is not listed on IDEAS
    19. Randall P. Ellis & Juan Gabriel Fernandez, 2013. "Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas," IJERPH, MDPI, vol. 10(11), pages 1-34, October.
    20. Cutler, David & Lincoln, Bryan & Zeckhauser, Richard, 2010. "Selection stories: Understanding movement across health plans," Journal of Health Economics, Elsevier, vol. 29(6), pages 821-838, December.
    21. Maria Anauati & Sebastian Galiani & Federico Weinschelbaum, 2015. "The rise of noncommunicable diseases in Latin America and the Caribbean: challenges for public health policies," Latin American Economic Review, Springer;Centro de Investigaciòn y Docencia Económica (CIDE), vol. 24(1), pages 1-56, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:15:y:2018:i:2:p:242-:d:129594. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.