Project Lead(s): Jahangir Khan
Issue
The reliance on out-of-pocket payments for health services leads to a catastrophic burden for many households in low-income countries like Bangladesh.
Like many low-income countries, a large share of employment in Bangladesh is in the informal sector and providing these workers with health insurance is a big challenge.
Solution
The project team in Bangladesh provided technical support to an occupational cooperative, the Labor Association for Social Protection (LASP), to establish and manage health insurance schemes for their workers.
In order to estimate the impact of the program, a quasi-experimental design was applied to compare insured LASP members with a group of similar workers in another cooperative who were not insured.
In total 1,352 informal-worker households were enrolled in the cooperative/scheme as members, which provided 6,532 individuals with access to health benefits.
The team assessed healthcare utilization, quality of care, health status and cost of care in insured workers, compared with the non-insurance matched controls.
Increasing the number of enrollees in the scheme every three months and collected data on revenues from the scheme (e.g., premiums, co-pay, etc.) as a share of total costs of healthcare of the scheme members were the data reviewed to estimate self-financing capacity of the scheme.
Outcome
Providing health insurance for informal workers was shown to be likely to increase the use of healthcare services from qualified providers at lower out-of-pocket payments.
Survey data showed that the use of healthcare services covered under the benefit plan was higher among insured members than their corresponding matched controls (12% and 3% respectively).
Utilization of ‘private clinic’ and ‘Medical College hospitals and district hospitals’ services were also higher for LASP beneficiaries (14% and 5% respectively) than control households (11% and 4% respectively).
Further analysis showed that out-of-pocket payments among LASP beneficiaries was 13.8% lower, in comparison with their corresponding controls.
Results of the project were released publicly through a number of seminars and symposia.
There are plans to expand the pilot scheme to six more areas in Bangladesh.