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.

<h4>Background</h4>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 finan...

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Autores principales:	Sayem Ahmed, Md Zahid Hasan, Nausad Ali, Mohammad Wahid Ahmed, Emranul Haq, Sadia Shabnam, Morseda Chowdhury, Breda Gahan, Christine Bousquet, Jahangir A M Khan, Ziaul Islam
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f6be6f8d47a14cd98de3f5bbb4816f2a
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spelling	oai:doaj.org-article:f6be6f8d47a14cd98de3f5bbb4816f2a2021-12-02T20:04:35ZEffectiveness 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.1932-620310.1371/journal.pone.0256067https://doaj.org/article/f6be6f8d47a14cd98de3f5bbb4816f2a2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0256067https://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.Sayem AhmedMd Zahid HasanNausad AliMohammad Wahid AhmedEmranul HaqSadia ShabnamMorseda ChowdhuryBreda GahanChristine BousquetJahangir A M KhanZiaul IslamPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11, p e0256067 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Sayem Ahmed Md Zahid Hasan Nausad Ali Mohammad Wahid Ahmed Emranul Haq Sadia Shabnam Morseda Chowdhury Breda Gahan Christine Bousquet Jahangir A M Khan Ziaul Islam 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.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.
format	article
author	Sayem Ahmed Md Zahid Hasan Nausad Ali Mohammad Wahid Ahmed Emranul Haq Sadia Shabnam Morseda Chowdhury Breda Gahan Christine Bousquet Jahangir A M Khan Ziaul Islam
author_facet	Sayem Ahmed Md Zahid Hasan Nausad Ali Mohammad Wahid Ahmed Emranul Haq Sadia Shabnam Morseda Chowdhury Breda Gahan Christine Bousquet Jahangir A M Khan Ziaul Islam
author_sort	Sayem Ahmed
title	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.
title_short	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.
title_full	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.
title_fullStr	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.
title_full_unstemmed	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.
title_sort	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.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/f6be6f8d47a14cd98de3f5bbb4816f2a
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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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