東華大學圖書館 |

Healthcare Financing Challenges and Opportunities to Achieving Universal Health Coverage in the Low- and Middle-Income Country Context.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Healthcare Financing Challenges and Opportunities to Achieving Universal Health Coverage in the Low- and Middle-Income Country Context./
作者:	Ahmed, Sayem.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2020,
面頁冊數:	98 p.
附註:	Source: Dissertations Abstracts International, Volume: 83-05, Section: B.
Contained By:	Dissertations Abstracts International83-05B.
標題:	Health care expenditures. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=28421725
ISBN:	9798515245078

Healthcare Financing Challenges and Opportunities to Achieving Universal Health Coverage in the Low- and Middle-Income Country Context.
Ahmed, Sayem.

Healthcare Financing Challenges and Opportunities to Achieving Universal Health Coverage in the Low- and Middle-Income Country Context. - Ann Arbor : ProQuest Dissertations & Theses, 2020 - 98 p.

Source: Dissertations Abstracts International, Volume: 83-05, Section: B.

Thesis (Ph.D.)--Karolinska Institutet (Sweden), 2020.

This item must not be sold to any third party vendors.

Background: In Bangladesh, on an average 62% of total healthcare spending was borne by households through out-of-pocket (OOP) payments annually during 2000-2015. Because of such high OOP payments, a sizable proportion of households (15.7%) faced catastrophic health expenditure (CHE) and a number of them fell into poverty in 2010. Protecting households from such payments and consequently, the risk of impoverishment are desirable objectives of health systems worldwide. The Sustainable Development Goals (SDGs) resolution emphasized ensuring quality and affordable essential health services through Universal Health Coverage (UHC) by 2030. In order to achieve UHC, the World Health Organization (WHO) recommends to ensure the protection against the risk of large healthcare payments or CHE by spreading the risk among the population through pre-payments e.g., tax, social security contribution, insurance premium. Informal workers in the agricultural and non-agricultural sectors including readymade garments (RMG) workers constitute a large proportion of the total labor force (88%), who contribute to 64% of the total Gross Domestic Products of Bangladesh. Efforts should, therefore, be made to ensure sustainable quality healthcare for this group of workers by bringing them under pre-payment health schemes. Community-Based health insurance (CBHI) and employer-sponsored health insurance (ESHI) schemes were thus piloted among selected informal workers with an aim to increase utilization of medically trained healthcare providers (MTPs) at an affordable price.Objectives: The main objective of this dissertation is twofold: firstly, to study the effect of the current healthcare financing system on the financial risk of households and secondly, to explore potential solutions through pre-payments schemes (CBHI and ESHI) for mitigating such challenges.Methods: Based on both primary and/or secondary data, five studies were conducted. In study I, nationally representative Household Income and Expenditure Survey, 2016 has been used which provide data on household consumption expenditure including health expenses. We calculated the incidence of CHE, which was later predicted by demographic and socio-economic characteristics of the households using multiple regression analysis. The incidence of CHE was defined as the proportion of households having healthcare expenditure of more than a threshold level such as 10% of their total consumption expenditure or 40% of their non-food consumption expenditure. We estimated the impoverishment effect of OOP payments using both the national (cost of basic need approach) and the international (1.90 International dollar per person per day) poverty line. For study II, 557 informal workers were surveyed during 2010-11 in three geographic locations (a metropolitan city, a district town and a sub-district area) to estimate the willingness-to-pay (WTP) for CBHI, using the contingent valuation method. The association between WTP and demographic characteristics was measured by employing the log-normal regression model. Study III adopted a case-control design to estimate the effect of the CBHI scheme on healthcare utilization from MTPs. We, therefore, surveyed 1,292 (646 insured and 646 uninsured) households after 1 year of implementation of the scheme. In order to minimise the unobserved baseline differences between the insured and uninsured groups, a propensity score matching was performed. A multilevel logistic regression model was applied to measure the association between MTP healthcare use and CBHI membership, in comparison to uninsured.

ISBN: 9798515245078Subjects--Topical Terms:

3433801
Health care expenditures.

Healthcare Financing Challenges and Opportunities to Achieving Universal Health Coverage in the Low- and Middle-Income Country Context.
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