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Impact of Community-Based and Employer-Sponsored Health Insurance Schemes on Equitable and Affordable Access to Healthcare: Experience from a Low Income Country

In Bangladesh, out-of-pocket (OOP) payments for healthcare constitute 63.3% of total healthcare expenditures. Due to such payments 15.6% of households face catastrophic health expenditure and almost 5 million people fall into poverty every year. Further, among those who afford to access healthcare, 41.6% utilize services from informal (village doctor, drug-sellers) and traditional providers (faith-based healers, Kabiraj etc.), which results in over-utilization of drugs and adverse effects of the treatment in many cases.

Informal workers in the agricultural and non-agricultural sector and readymade garments (RMG) worker constitute large proportion of the total labor force in Bangladesh. Community based health insurance (CBHI) and ‘employer-sponsored health insurance’ (ESHI) schemes was implemented among informal workers and RMG workers respectively with an aim to increase medically trained healthcare provider at affordable price.

Aim of the project

The main objective is two-fold: firstly, to study the impact of existing healthcare financing system on financial risk of households and economic impoverishment and secondly, to explore potential solutions through community-based and employer sponsored health insurance for mitigating such challenges. Both primary and/or secondary data will be employed in these studies. National level secondary data will be obtained from the three consecutive ‘Household Income and Expenditure Surveys’ for years 2000, 2005 and 2010 conducted by Bangladesh Bureau of Statistics. Quasi-experimental case-control study will be conducted to examine the impact of CBHI and ESHI schemes. Comparison will be made between intervention and comparison groups in terms of healthcare utilization from medically trained providers and OOP payments of the users.

Results in brief

There are no results from the project yet.

Continued work

The project is expected to be finished in 2019.

Contact person


Sayem Ahmed

Enhet: MMC/Health Economics and Policy