title: The impact of Gonoshasthaya Kendra's Micro Health Insurance plan on antenatal care among poor women in rural Bangladesh.
abstract: Low utilization of antenatal care (ANC) by pregnant women, particularly in rural areas, is an obstacle to ensuring safe motherhood in Bangladesh. Currently, Micro Health Insurance (MHI) is being considered in many developing countries as a potential method for assuring greater access to health care, especially for the poor. So far, there is only limited evidence evaluating MHI schemes. This study assesses the impact of MHI administered by Gonoshasthaya Kendra (GK) on ANC utilization by poor women in rural Bangladesh. We conducted a questionnaire survey and collected 321 valid responses from women enrolled in GK's MHI scheme and 271 from women not enrolled in any health insurance plan. We used a two-part model in which dependent variables were whether or not women utilized ANC and the number of times ANC was used. The model consisted of logistic regression analysis and ordinary least squares regression analysis. The main independent variables were dummies for socioeconomic classes according to GK, each of which represented the premiums and co-payments charged by class. The results showed that destitute, ultra-poor, and poor women enrolled in MHI used ANC significantly more than women not enrolled in health insurance. Women enrolled in MHI, except for those who were destitute or ultra-poor, utilized ANC significantly more times than women not enrolled in health insurance. We assume that GK's sliding premium and co-payment scales are key to ANC utilization by women. Expanding the MHI scheme may enhance ANC utilization among poor women in rural Bangladesh.
authors.affiliation: Health Care Economics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. abir.hce@tmd.ac.jp
authors.forename: Mohammad Touhidul
authors.initials: MT
authors.lastname: Islam
authors.forename: Isao
authors.initials: I
authors.lastname: Igarashi
authors.forename: Koichi
authors.initials: K
authors.lastname: Kawabuchi
mesh_terms: D000328:Adult; D001459:Bangladesh; D003710:Demography; D005260:Female; D019538:Health Care Surveys / Q000191:economics / Q000706:statistics & numerical data; D006285:Health Planning / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D009938:Organizations / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics* / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D055815:Young Adult