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Ahmed S.,Health Economics and Financing Research Group | Ahmed S.,Karolinska Institutet | Hoque M.E.,University of Queensland | Sarker A.R.,Health Economics and Financing Research Group | And 6 more authors.
PLoS ONE | Year: 2016

Introduction Reliance on out-of-pocket payment for healthcare may lead poor households to undertake catastrophic health expenditure, and risk-pooling mechanisms have been recommended to mitigate such burdens for households in Bangladesh. About 88% of the population of Bangladesh depends on work in the informal sector. We aimed to estimate willingness-to-pay (WTP) for CBHI and identify its determinants among three categories of urban informal workers rickshaw-pullers, shopkeepers and restaurant workers. Methods The bidding game version of contingent valuation method was used to estimate weekly WTP. In three urban locations 557 workers were interviewed using a structured questionnaire during 2010 and 2011. Multiple-regression analysis was used to predict WTP by demographic and household characteristics, occupation, education level and past illness. Results WTP for a CBHI scheme was expressed by 86.7% of informal workers. Weekly average WTP was 22.8 BDT [Bangladeshi Taka; 95% confidence interval (CI) 20.9-24.8] or 0.32 USD and varied significantly across occupational groups (p = 0.000) and locations (p = 0.003). WTP was highest among rickshaw-pullers (28.2 BDT or 0.40 USD; 95% CI: 24.7-31.7), followed by restaurant workers (20.4 BDT 0.29 USD; 95% CI: 17.0-23.8) and shopkeepers (19.2 BDT or 0.27 USD; 95% CI: 16.1-22.4). Multiple regression analysis identified monthly income, occupation, geographical location and educational level as the key determinants of WTP. WTP increased 0.196% with each 1% increase in monthly income, and was 26.9% lower among workers with up to a primary level of education versus those with higher than primary, but less than one year of education. Conclusion Informal workers in urban areas thus are willing to pay for CBHI and socioeconomic differences explain the magnitude of WTP. The policy maker might think introducing communitybased model including public-community partnership model for healthcare financing of informal workers. Decision making regarding the implementation of such schemes should consider worker location and occupation. © 2016 Ahmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Khan J.A.,Health Economics and Financing Research Group | Khan J.A.,Karolinska Institutet | Ahmed S.,Health Economics and Financing Research Group
Health Economics Review | Year: 2013

Background: The reliance on out-of-pocket payments for health services leads to a catastrophic burden for many households in Bangladesh. The World Health Organization suggests that risk-pooling mechanisms should be used for financing healthcare. Like many low-income countries (LIC), a large share of employment in Bangladesh is in the informal sector (88%). Inclusion of these workers in health insurance is a big challenge. Among other barriers, the "literacy gap" for health insurance is a reason for the low insurance uptake in Bangladesh. The aim of this study is, therefore, to assess the impact of an educational intervention on willingness-to-pay (WTP) for health insurance among informal sector workers in urban Bangladesh. Method: An educational intervention on occupational solidarity and health insurance is offered to groups of informal workers. Educational sessions take place once a week (3-4 hours) during three subsequent weeks for each occupational group. For assessing the impact of the educational intervention, WTP for joining health insurance using occupational solidarity between workers in "pre- and post-treatment" periods as well as between "control and treatment" groups were compared. Multiple-regression analysis is applied for predicting WTP by educational intervention, while controlling for demographic and socioeconomic characteristics. Results: The coefficient of variation (CoV) of the WTP is estimated in control and treatment groups and expected to be lower in the latter. The WTP for health insurance is higher (33.8%) among workers who joined the educational intervention in comparison with those who did not (control group). CoV of WTP is found to be generally lower in post-treatment period and in treatment group compared to pre-treatment period and control group respectively. Conclusion: Educational interventions can be used for increasing demand for health insurance scheme using occupational solidarity among informal sector workers. © 2013 Khan and Ahmed; licensee Springer.

PubMed | Health Economics and Financing Research Group and Health Economics Unit
Type: Journal Article | Journal: International journal of health policy and management | Year: 2016

Measuring health status by using standardized and validated instrument has become a growing concern over the past few decades throughout the developed and developing countries. The aim of the study was to investigate the overall self-reported health status along with potential inequalities by using EuroQol 5 dimensions (EQ-5D) instrument among low-income people of Bangladesh.A cross-sectional household survey was conducted in Chandpur district of Bangladesh. Bangla version of the EQ-5D questionnaire was employed along with socio-demographic information. EQ-5D questionnaire composed of 2-part measurements: EQ-5D descriptive system and the visual analogue scale (VAS). For measuring health status, UK-based preference weights were applied while higher score indicated better health status. For facilitating the consistency with EQ-5D score, VASs were converted to a scale with scores ranging from 0 to 1. Multiple logistic regression models were also employed to examine differences among EQ-5D dimensions.A total of 1433 respondents participated in the study. The mean EQ-5D and VAS score was 0.76 and 0.77, respectively. The females were more likely to report any problem than the males (P < 0.001). Compared to the younger, elderly were more than 2-3 times likely to report any health problem in all EQ-5D dimensions (OR [odds ratio] = 3.17 for mobility, OR = 3.24 for self-care). However, the respondents of the poorest income group were significantly suffered more from every EQ-5D dimension than the richest income quintile.Socio-economic and demographic inequalities in health status was observed in the study. Study suggests to do further investigation with country representative sample to measure the inequalities of overall health status. It would be helpful for policy-maker to find a new way aiming to reduce such inequalities.

Khan J.A.M.,Health Economics and Financing Research Group | Khan J.A.M.,Brac University | Khan J.A.M.,Karolinska Institutet | Mahumud R.A.,Health Economics and Financing Research Group | Mahumud R.A.,Brac University
Health Economics Review | Year: 2015

South-East Asian Regional (SEAR) countries range from low- to middle-income countries and have considerable differences in mix of public and private sector expenditure on health. This study intends to estimate the income-elasticities of healthcare expenditure in public and private sectors separately for investigating whether healthcare is a ‘necessity’ or ‘luxury’ for citizens of these countries. Panel data from 9 SEAR countries over 16 years (1995-2010) were employed. Fixed- and random-effect models were fitted to estimate income-elasticity of public, private and total healthcare expenditure. Results showed that one percent point increase in GDP per capita increased private expenditure on healthcare by 1.128%, while public expenditure increased by only 0.412%. Inclusion of three-year lagged variables of GDP per capita in the models did not have remarkable influence on the findings. The citizens of SEAR countries consider healthcare as a necessity while provided through public sector and a luxury when delivered by private sector. By increasing the public provisions of healthcare, more redistribution of healthcare resources can be ensured, which can accelerate the journey of SEAR countries towards universal health coverage. © 2015, Khan and Mahumud; licensee Springer.

Sarker B.K.,Center for Reproductive Health | Ahmed S.,Health Economics and Financing Research Group | Islam N.,Center for Reproductive Health | Khan J.A.M.,Health Economics and Financing Research Group | Khan J.A.M.,Karolinska Institutet
Cost Effectiveness and Resource Allocation | Year: 2013

Background: The cost of behavior change communication (BCC) interventions has not been rigorously studied in Bangladesh. This study was conducted to assess the implementation costs of a BCC intervention in a maternal, neonatal and child health program (Manoshi) run by BRAC, which has been operating in the urban slums of Dhaka since 2007. The study estimates the costs of BCC tools per exposure among the different types of BCC channels: face-to-face, group counseling, and mass media.Methods: The study was conducted from November 2010 to April 2011 in the Dhaka urban slum area. A micro-costing approach was applied using primary and secondary data sources to estimate the cost of BCC tools. Primary data were collected through interviews with service-providers and managers from the Manoshi program, observations of group counseling, and mass media events.Results: Per exposure, the cost of face-to-face counseling was found to be 3.08 BDT during pregnancy detection, 3.11 BDT during pregnancy confirmation, 12.42 BDT during antenatal care, 18.96 BDT during delivery care and 22.65 BDT during post-natal care. The cost per exposure of group counseling was 22.71 BDT (95% CI 21.30-24.87) for Expected Date of Delivery (EDD) meetings, 14.25 BDT (95% CI 12.37-16.12) for Women Support Group meetings, 17.83 BDT (95% CI 14.90-20.77) for MNCH committee meetings and 6.62 BDT (95% CI 5.99-7.26) for spouse forum meetings. We found the cost per exposure for mass media interventions was 9.54 BDT (95% CI 7.30-12.53) for folk songs, 26.39 BDT (95% CI 23.26-32.56) for street dramas, 0.39 BDT for TV-broadcasting and 7.87 BDT for billboards. Considering all components reaching the target audience under each broader type of channel, the total cost per exposure was found to be 60.22 BDT (0.82 USD) for face-to-face counseling, 61.40 BDT (0.82 USD) for group counseling and 44.19 BDT (0.61 USD) for mass media.Conclusions: The total cost for group counseling was the highest per exposure, followed by face-to-face counseling and mass media. The cost per exposure varied substantially across BCC channels due to differences in cost drivers such as personnel, materials and refreshments. The cost per exposure can be valuable for planning and resource allocation related to the implementation of BCC interventions in low resource settings. © 2013 Sarker et al.; licensee BioMed Central Ltd.

PubMed | Karolinska Institutet, Health Economics and Financing Research Group and Brac University
Type: | Journal: SpringerPlus | Year: 2014

The impact of age and sex on health care expenditure has recently become one of the major concerns in many developing countries like Bangladesh. Age and sex differences in the use of health care services can be substantial at several stages of life which are reflected in overall healthcare expenditure. We examined the impact of age and sex of the population on overall healthcare expenditure of households in Bangladesh. A total of 10,705 populations who spent for receiving any type of healthcare services were analyzed from Bangladesh Household Income and Expenditure Survey data, 2010. Sex and age group were considered as childhood (0-19), young adult (20-39), middle-aged adult (40-64), senior aged (65-84) and old senior aged (84+) for the entire analysis. Total healthcare expenditure was derived by considering direct cost such as physicians fee, cost of medicine, diagnostic, transportation, tips and informal payment etc. Indirect and intangible cost was not considered in the analysis. The study found that overall health care expenditure of male (US$ 11.5) is higher than female (US$ 11.2) while this is higher for female (US$ 14.2) than male (US$ 11.3) in the reproductive age. The highest health expenditure was observed in male (US$ 69.7) of age 65-69 years and in female (US$ 23.4) of age 75-79 years. The cost for hospitalization was significantly higher (US $23.7) for female than male (US$ 21.1). Overall health expenditure was observed to be significantly higher in elderly than younger people. These findings provide an experimental framework for the continuing inquiry of equity in the allocation of health care expenditure between male and female at different age, which suggest current health care system in Bangladesh place a significant financial strain on the elderly population.

Sultana M.,Health Economics and Financing Research Group | Alam Mahumud R.,Health Economics and Financing Research Group | Razzaque Sarker A.,Health Economics and Financing Research Group | Mahmud Hossain S.,Northern University of Bangladesh
Risk Management and Healthcare Policy | Year: 2016

Hand hygiene has achieved the reputation of being a convenient means of preventing communicable diseases. Although causal links between hand hygiene and rates of infectious disease have also been established earlier, studies focusing on hand hygiene among universitygoing students are not adequate in number. This study evaluated handwashing knowledge, practice, and other related factors among the selected university students in the city of Dhaka, Bangladesh. A cross-sectional study was conducted among 200 undergraduate students from four selected universities. A pretested, semistructured questionnaire, that included a checklist associated with handwashing practice, was applied to capture all relevant data. The mean (± SD) age of the participants was 20.4 (±1.8) years. The majority of the students washed their hands with water, but only 22.5% washed their hands effectively by maintaining the correct steps and frequency of handwashing with water, and soap or hand sanitizer. The mean (± SD) score of the participants’ hand hygiene practice was 50.81 (±4.79), while the total score with all perfect answers was considered as 66. Regression coefficient demonstrated that age has a negative influence on hand hygiene practice, as older students have lower scores compared to the younger ones (P,0.01). However, the unmarried students were a significant predictor for influencing the incensement of handwashing practice compared to the married ones (P,0.01). Findings of this study designate widespread insufficient hand hygiene practice in the university-going students and indicate a need for an extensive public health education program on this topic. Furthermore, availability of soap and sufficient water supply is needed within the university setting to facilitate handwashing. Therefore, supporting quantity and quality of available campus-based public health education programs along with providing health-washing equipment is suggested. © 2016 Sultana et al.

To estimate additional total cost and average cost of integrating the demand-based reproductive health commodity model into the existing Government and NGO facilities in Bangladesh. Activity based cost analysis was conducted during 2006-2008 in two low performing rural sub-districts (Nabigong and Raipur sub-district) and one urban slum area in Dhaka city, Bangladesh. Activity-based cost data were collected using ingredient approach, which comprised of listing all types of inputs by activity, quantities and prices for each input. Total cost was presented according to capital and recurrent items. The supply side perspective was considered for entire analysis. The total cost of integrating demand-based reproductive health commodity (DBRHC) model into the Government and NGO service delivery system was estimated to BDT 18,667,634 (US$274,524). The proportion of capital cost was 59% and the recurrent cost was 41% of the total cost. The average cost per beneficiaries was BDT 230 (US$3.38) only for introducing this model into the existing health system. The built-in interventions of DBRHC model were doable at low-cost at the selected Government and NGO settings at the grass-root level. The model has potential of further cost containment during scaling up-if the intervention costs are adjusted with the existing functionaries of the Government and NGOs.

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