BMJ public health · 2025
Willingness-to-pay for community-based health insurance among formal and informal doctors in Dhaka, Bangladesh: a comparative cross-sectional study.
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Al Fidah Md Fuad, Efa Syeda Sumaiya, Islam Md Ziaul
Аннотация
INTRODUCTION: Health insurance enables financial protection and reduces medical burdens. Currently, less than 1% of Bangladeshi citizens have health insurance coverage. We aimed to assess the willingness-to-pay for community-based health insurance and explore associated factors among formal and informal doctors in Bangladesh.
METHODS: This comparative cross-sectional study was conducted on Bangladeshi doctors with formal and informal employment. For each group, 116 doctors were selected via purposive sampling, as no national register of doctors was available, indicating their current employment status and purposive selection ensured equal inclusion of formal and informal doctors. Separate binomial logistic regression models were fitted for each independent variable, adjusting for age and sex. The mean willingness-to-pay (95% CI) was measured using the double-bounded dichotomous choice approach of the contingent valuation method.
RESULTS: The median (IQR) age of the doctors was 34 (31.75-36.0) years, and 53.0% were male. Most (79.7%; 95% CI 74.0% to 84.7%) doctors exhibited willingness-to-pay for community-based health insurance with higher proportion among formal (85.3%) than informal (74.1%) doctors. The overall mean (95% CI) willingness-to-pay was 5.6% (5.1% to 6.2%) of monthly personal income and was higher among informal (5.8%; 5.0% to 6.6%) than formal (5.4%; 4.6% to 6.1%) doctors. Doctors seeking healthcare (adjusted OR (AOR): 0.28; 95% CI 0.08 to 0.99; p value=0.048) and having a middle career (AOR: 0.32; 95% CI 0.11 to 0.90; p value=0.031) were associated with lower odds of being willing-to-pay. Despite having lower mean willingness-to-pay, formal doctors showed higher odds (AOR: 2.02; 95% CI 1.01 to 4.07; p value=0.048) of accepting community-based health insurance.
CONCLUSIONS: Both formal and informal doctors showed high willingness-to-pay for community-based health insurance. Formal doctors were likely to contribute, while informal doctors expressed higher mean payments. Communication campaigns, tiered premiums and better healthcare quality could enhance participation. These findings offer insights for designing provider-supported community-based health insurance models that foster trust, include low-income groups and support universal health coverage in Bangladesh.
METHODS: This comparative cross-sectional study was conducted on Bangladeshi doctors with formal and informal employment. For each group, 116 doctors were selected via purposive sampling, as no national register of doctors was available, indicating their current employment status and purposive selection ensured equal inclusion of formal and informal doctors. Separate binomial logistic regression models were fitted for each independent variable, adjusting for age and sex. The mean willingness-to-pay (95% CI) was measured using the double-bounded dichotomous choice approach of the contingent valuation method.
RESULTS: The median (IQR) age of the doctors was 34 (31.75-36.0) years, and 53.0% were male. Most (79.7%; 95% CI 74.0% to 84.7%) doctors exhibited willingness-to-pay for community-based health insurance with higher proportion among formal (85.3%) than informal (74.1%) doctors. The overall mean (95% CI) willingness-to-pay was 5.6% (5.1% to 6.2%) of monthly personal income and was higher among informal (5.8%; 5.0% to 6.6%) than formal (5.4%; 4.6% to 6.1%) doctors. Doctors seeking healthcare (adjusted OR (AOR): 0.28; 95% CI 0.08 to 0.99; p value=0.048) and having a middle career (AOR: 0.32; 95% CI 0.11 to 0.90; p value=0.031) were associated with lower odds of being willing-to-pay. Despite having lower mean willingness-to-pay, formal doctors showed higher odds (AOR: 2.02; 95% CI 1.01 to 4.07; p value=0.048) of accepting community-based health insurance.
CONCLUSIONS: Both formal and informal doctors showed high willingness-to-pay for community-based health insurance. Formal doctors were likely to contribute, while informal doctors expressed higher mean payments. Communication campaigns, tiered premiums and better healthcare quality could enhance participation. These findings offer insights for designing provider-supported community-based health insurance models that foster trust, include low-income groups and support universal health coverage in Bangladesh.