{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:04:16Z","timestamp":1791417856007,"version":"4.3.3"},"reference-count":27,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2018,1,31]],"date-time":"2018-01-31T00:00:00Z","timestamp":1517356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Grand Challenge Canada","award":["GR01009"],"award-info":[{"award-number":["GR01009"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Community-based Health Insurance (CBHI) schemes are recommended for providing financial risk protection to low-income informal workers in Bangladesh. We assessed the problem of adverse selection in a pilot CBHI scheme in this context. In total, 1292 (646 insured and 646 uninsured) respondents were surveyed using the Bengali version of the EuroQuol-5 dimensions (EQ-5D) questionnaire for assessing their health status. The EQ-5D scores were estimated using available regional tariffs. Multiple logistic regression was applied for predicting the association between health status and CBHI scheme enrolment. A higher number of insured reported problems in mobility (7.3%; p = 0.002); self-care (7.1%; p = 0.000) and pain and discomfort (7.7%; p = 0.005) than uninsured. The average EQ-5D score was significantly lower among the insured (0.704) compared to the uninsured (0.749). The regression analysis showed that those who had a problem in mobility (m 1.25\u20132.17); self-care (OR = 2.29; 95% CI: 1.62\u20133.25) and pain and discomfort (OR = 1.43; 95% CI: 1.13\u20131.81) were more likely to join the scheme. Individuals with higher EQ-5D scores (OR = 0.46; 95% CI: 0.31\u20130.69) were less likely to enroll in the scheme. Given that adverse selection was evident in the pilot CBHI scheme, there should be consideration of this problem when planning scale-up of these kind of schemes.<\/jats:p>","DOI":"10.3390\/ijerph15020242","type":"journal-article","created":{"date-parts":[[2018,1,31]],"date-time":"2018-01-31T12:41:24Z","timestamp":1517402484000},"page":"242","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Adverse Selection in Community Based Health Insurance among Informal Workers in Bangladesh: An EQ-5D Assessment"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9499-1500","authenticated-orcid":false,"given":"Sayem","family":"Ahmed","sequence":"first","affiliation":[{"name":"Health Economics and Financing Research Group, Health Systems and Population Studies Division, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"},{"name":"Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, SE-171 77 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdur","family":"Sarker","sequence":"additional","affiliation":[{"name":"Health Economics and Financing Research Group, Health Systems and Population Studies Division, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"},{"name":"Department of Management Science, University of Strathclyde, Glasgow G1 1XQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marufa","family":"Sultana","sequence":"additional","affiliation":[{"name":"Health Economics and Financing Research Group, Health Systems and Population Studies Division, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"},{"name":"Faculty of Health, Deakin University, Melbourne, VIC 3125, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanchita","family":"Chakrovorty","sequence":"additional","affiliation":[{"name":"Health Economics and Financing Research Group, Health Systems and Population Studies Division, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"},{"name":"Department of Agriculture Economics, Purdue University, IN 47907, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3824-8947","authenticated-orcid":false,"given":"Md.","family":"Hasan","sequence":"additional","affiliation":[{"name":"Health Economics and Financing Research Group, Health Systems and Population Studies Division, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7622-0937","authenticated-orcid":false,"given":"Andrew","family":"Mirelman","sequence":"additional","affiliation":[{"name":"Centre for Health Economics, University of York, York YO10 5DD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jahangir","family":"Khan","sequence":"additional","affiliation":[{"name":"Health Economics and Financing Research Group, Health Systems and Population Studies Division, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"},{"name":"Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, SE-171 77 Stockholm, Sweden"},{"name":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1056\/NEJMra1110897","article-title":"Health care systems in low- and middle-income countries","volume":"370","author":"Mills","year":"2014","journal-title":"N. 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