Do employer-sponsored health insurance schemes affect the utilisation of medically trained providers and out-of-pocket payments among ready-made garment workers? A case–control study in Bangladesh

Ahmed, Sayem; Sarker, Abdur Razzaque; Sultana, Marufa; Roth, Felix; Mahumud, Rashidul Alam; Kamruzzaman, Md; Hasan, Zahid; Mirelman, Andrew; Islam, Ziaul; Niessen, Louis; Rehnberg, Clas; Khan, Abid Hossain; Gyr, Niklaus; Khan, Jahangir

doi:10.1136/bmjopen-2019-030298

Cited by 9 publications

(25 citation statements)

References 35 publications

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“…Nevertheless, within the insured, income increases OOP. These outcomes support previous studies (Ahmed et al, 2020;Harish et al, 2020;Sriram and Khan, 2020) that established that health insurance reduces health spending through risk pooling. We further clarify that these expenditure-reducing effects of insurance accrue at the lower tail of income distribution.…”

Section: Discussionsupporting

confidence: 89%

“…However, empirical evidence reveals different outcomes. In some contexts health insurance indeed reduces OOP expenditure (Ahmed et al, 2020;Harish et al, 2020;Sriram and Khan, 2020) while increasing the OOP expenditure in alternative settings (Li et al, 2020;Okoroh et al, 2020;Ying and Chang, 2020). These contradictions invite the question whether policy should expand or contract the provision and coverage of health insurance in the best interest of citizens.…”

Section: Introductionmentioning

confidence: 99%

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Health Insurance and Out-Of-Pocket Expenditure on Health and Medicine: Heterogeneities along Income

2021

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Background: Achieving universal health coverage is an important objective enshrined in the 2015 global Sustainable Development Goals. However, the rising cost of healthcare remains an obstacle to the attainment of the universal health coverage. Health insurance is considered an option to reduce out-of-pocket (OOP) expenditure on health and medicine. Nevertheless, the relationship between insurance and the OOP along welfare distributions is not well understood. This study investigates the heterogeneous association between health insurance and OOP expenditure on health and medicine, along income, using data from the Kingdom of Saudi Arabia.Methods: This study used data of 8655 individuals drawn from the Saudi Family Health Survey conducted in 2018. The study adopts Tobit models to account for possible corner solution due to individuals with zero expenditure on health. We minimize the confounding effects of non-random selection into the insurance program by estimating the Tobit equations on a sample weighted by inverse propensity scores of insurance participation. In addition, we test whether the health insurance differently relates to OOP on health and medicine amongst people with access to free medical care as opposed to those without this privilege. The study estimates separate models for OOP expenditure on health and on medicines.Results: Health insurance reduces OOP expenditure on health by 2.0% and OOP expenditure on medicine by 2.4% amongst the general population while increasing the OOP expenditure on health by 0.2% and OOP expenditure on medicine by 0.2%, once income of the insured rises. The relationship between the insurance and OOP expenditure is robust only amongst the citizens, a sub-sample that also has access to free public healthcare. Specifically, the insurance reduces OOP expenditure on health by 3.6% and OOP on medicine by 5.2% and increases OOP expenditure on health by 0.4% and OOP expenditure on medicine by 0.5% once income of the insured increases amongst Saudi citizens. In addition, targeting medicines can lead to greater changes in OOP. The relationship between insurance and OOP is stronger for medicine relative to that observed on health expenditure.Conclusion: Our findings suggest that insurance induces different effects along the income spectrum. Hence, policy needs to be aware of the possible welfare distribution impacts of upscaling or downscaling the coverage of insurance amongst the populations, while pursuing universal healthcare coverage.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Health Insurance and Out-Of-Pocket Expenditure on Health and Medicine: Heterogeneities along Income

2021

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“…A recent study conducted by Ahmed et al in selected garments factories found that employer‐sponsored health insurance (ESHI) scheme increased healthcare utilization of medically trained providers and reduce out‐of‐pocket expenditure among insured RMG workers compared with uninsured RMG workers in Bangladesh. 30 The study recommended that educational interventions can be provided to RMG workers to improve their healthcare‐seeking behaviors and increase their utilization of ESHI‐designated scheme. Our findings also suggest that affordable health insurance policy can be made available to the garments workers by the factory owners which would likely improve their formal healthcare utilization and reduce out‐of‐pocket expenditure.…”

Section: Discussionmentioning

confidence: 99%

“…Only 10.5% of the survey respondents reported that they know about health insurance. A recent study conducted by Ahmed et al in selected garments factories found that employer‐sponsored health insurance (ESHI) scheme increased healthcare utilization of medically trained providers and reduce out‐of‐pocket expenditure among insured RMG workers compared with uninsured RMG workers in Bangladesh 30 . The study recommended that educational interventions can be provided to RMG workers to improve their healthcare‐seeking behaviors and increase their utilization of ESHI‐designated scheme.…”

Section: Discussionmentioning

confidence: 99%

Health sufferings, healthcare seeking behavior, awareness about health insurance, and health related rights of ready made garments workers in Bangladesh: Findings from a cross-sectional study

Hasan

Amin

Chowdhury

et al. 2021

Journal of Occupational Health

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Objectives This study aimed at examining health sufferings of readymade garments (RMG) workers, the factors that affect their health sufferings, their healthcare seeking pattern, knowledge about health insurance and health related rights in Bangladesh. Methods A cross‐sectional study was conducted among 486 RMG workers recruited randomly from eight garments factories located on the periphery of Dhaka, Bangladesh. The prevalence of musculoskeletal pain, headache, fever and abdominal pain was estimated and multivariable logistic regression analysis was performed to examine association between these illnesses of workers and their socio‐demographic characteristics and other work related information. We also explored their healthcare seeking patterns, knowledge about health insurance and health related rights. Results The prevalence of musculoskeletal pain, headache, fever and abdominal pain was found to be 78.1%, 57.9%, 52.2% and 24.6%, respectively, among the RMG workers. Factors that increased the odds of: musculoskeletal pain were working for more than 10 h per day (adjusted odds ratio [AOR]: 2.3, 95% confidence interval [CI]: 1.1–4.7) and being female [AOR: 4.6, 95% CI: 2.0–10.6]; fever was living in slums [AOR: 1.9, 95% CI: 1.1–3.5]; and abdominal pain was being female [AOR: 3.6, 95% CI: 1.4–9.3]. The workers commonly reported visiting drug sellers in local pharmacies for reported illnesses. They also had better knowledge of health related rights but poor knowledge of health insurance. Conclusion In order to address the overall health and well‐being of the RMG workers, it is imperative to lay out a blueprint for a safe and healthy workplace.

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“… 2) Labour Association for Social Protection (LASP) 2012, a health insurance scheme for informal worker [ 27 , 54 ]. 3) BADAS health insurance scheme for Ready-Made Garments (RMG) workers [ 55 ]. …”

Section: Resultsmentioning

confidence: 99%

Effectiveness of health voucher scheme and micro-health insurance scheme to support the poor and extreme poor in selected urban areas of Bangladesh: An assessment using a mixed-method approach

et al. 2021

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Background National healthcare financing strategy recommends tax-based equity funds and insurance schemes for the poor and extreme poor living in urban slums and pavements as the majority of these population utilise informal providers resulting in adverse health effects and financial hardship. We assessed the effect of a health voucher scheme (HVS) and micro-health insurance (MHI) scheme on healthcare utilisation and out-of-pocket (OOP) payments and the cost of implementing such schemes. Methods HVS and MHI schemes were implemented by Concern Worldwide through selected NGO health centres, referral hospitals, and private healthcare facilities in three City Corporations of Bangladesh from December 2016 to March 2020. A household survey with 1,294 enrolees, key-informant interviews, focus group discussions, consultative meetings, and document reviews were conducted for extracting data on healthcare utilisation, OOP payments, views of enrolees, and suggestions of implementers, and costs of services at the point of care. Results Healthcare utilisation including maternal, neonatal and child health (MNCH) services, particularly from medically trained providers, was higher and OOP payments were lower among the scheme enrolees compared to corresponding population groups in general. The beneficiaries were happy with their access to healthcare, especially for MNCH services, and their perceived quality of care was fair enough. They, however, suggested expanding the benefits package, supported by an additional workforce. The cost per beneficiary household for providing services per year was €32 in HVS and €15 in MHI scheme. Conclusion HVS and MHI schemes enabled higher healthcare utilisation at lower OOP payments among the enrolees, who were happy with their access to healthcare, particularly for MNCH services. However, they suggested a larger benefits package in future. The provider’s costs of the schemes were reasonable; however, there are potentials of cost containment by purchasing the health services for their beneficiaries in a competitive basis from the market. Scaling up such schemes addressing the drawback would contribute to achieving universal health coverage.

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Do employer-sponsored health insurance schemes affect the utilisation of medically trained providers and out-of-pocket payments among ready-made garment workers? A case–control study in Bangladesh

Cited by 9 publications

References 35 publications

Health Insurance and Out-Of-Pocket Expenditure on Health and Medicine: Heterogeneities along Income

Health Insurance and Out-Of-Pocket Expenditure on Health and Medicine: Heterogeneities along Income

Health sufferings, healthcare seeking behavior, awareness about health insurance, and health related rights of ready made garments workers in Bangladesh: Findings from a cross-sectional study

Effectiveness of health voucher scheme and micro-health insurance scheme to support the poor and extreme poor in selected urban areas of Bangladesh: An assessment using a mixed-method approach

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