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

Abstract

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.

Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis

“…Finally, 149 full texts articles were assessed and further screened using the predesigned selection criteria. Sixty-one studies met the inclusion criteria for data extraction and were included in the review [ 38 – 98 ], whereas 88 studies were excluded for the following reasons: the study employed an ineligible identification strategy (n = 63) [ 99 – 161 ], reported data from a sample already included in the review (n = 11) [ 162 – 172 ], case studies, reviews (n = 7) [ 27 , 173 – 178 ], the evaluated insurance scheme is not a CBHI (n = 6) [ 179 – 184 ], and could not isolate the impact of CBHI scheme (n = 1) [ 185 ] – S2 Table .…”

Enrollment and clients’ satisfaction with a community-based health insurance scheme: a community-based survey in Northwest Ethiopia

“…However, in practice, CBHI frequently falls short of its potential, mainly due to low levels of involvement [24]. The commitment of authorities to support the program, and the attitude and awareness of the community towards the importance of health insurance services determine the enrollment and inclusion of individuals in the scheme [25][26][27][28]. Financial constraints and informal sector and economy dominance are also posing a problem of enrollment in the CBHI scheme because it is challenging to reach them through traditional enrollment channels.…”