Effectiveness of health voucher scheme and micro-health insurance scheme to support the poor and extreme poor in selected urban areas of Bangladesh: An assessment using a mixed-method approach

Background National healthcare financing strategy recommends tax-based equity funds and insurance schemes for the poor and extreme poor living in urban slums and pavements as the majority of these population utilise informal providers resulting in adverse health effects and financial hardship. We assessed the effect of a health voucher scheme (HVS) and micro-health insurance (MHI) scheme on healthcare utilisation and out-of-pocket (OOP) payments and the cost of implementing such schemes. Methods HVS and MHI schemes were implemented by Concern Worldwide through selected NGO health centres, referral hospitals, and private healthcare facilities in three City Corporations of Bangladesh from December 2016 to March 2020. A household survey with 1,294 enrolees, key-informant interviews, focus group discussions, consultative meetings, and document reviews were conducted for extracting data on healthcare utilisation, OOP payments, views of enrolees, and suggestions of implementers, and costs of services at the point of care. Results Healthcare utilisation including maternal, neonatal and child health (MNCH) services, particularly from medically trained providers, was higher and OOP payments were lower among the scheme enrolees compared to corresponding population groups in general. The beneficiaries were happy with their access to healthcare, especially for MNCH services, and their perceived quality of care was fair enough. They, however, suggested expanding the benefits package, supported by an additional workforce. The cost per beneficiary household for providing services per year was €32 in HVS and €15 in MHI scheme. Conclusion HVS and MHI schemes enabled higher healthcare utilisation at lower OOP payments among the enrolees, who were happy with their access to healthcare, particularly for MNCH services. However, they suggested a larger benefits package in future. The provider’s costs of the schemes were reasonable; however, there are potentials of cost containment by purchasing the health services for their beneficiaries in a competitive basis from the market. Scaling up such schemes addressing the drawback would contribute to achieving universal health coverage.

The Bangladesh Maternal Health Voucher Scheme: impact on completeness of antenatal care provision

This study aimed to assess completeness of antenatal care coverage following implementation of a voucher scheme for maternal health in Bangladesh. The investigation used interview data from a survey conducted in Bangladesh in 2017 of 2400 randomly selected women aged 15–49 with children aged 0–23 months in four geographical areas where voucher scheme implementation was underway. Of these women, 1944 had attended at least one antenatal clinic visit so were included in the analysis. A ‘completeness index’ for antenatal visits was constructed as an outcome variable based on recall of thirteen elements of care. Bivariate analysis against independent variables of interest was carried out and multivariate linear regression models developed to examine the influence of voucher scheme participation on completeness of antenatal care adjusting for socio-demographic characteristics. Voucher scheme membership was associated with higher ‘completeness index’ scores, with a mean score of 185.2±101.0 for voucher recipients and 139.6 ± 93.3 for non-recipients (p<0.001). Scheme membership reduced the differentials associated with health facility type and socioeconomic status. Women from the lowest socioeconomic group who were voucher recipients received substantially more components of antenatal care (mean score: 159.6±82.1) compared with non-recipients (mean score: 115.7±83.0). This favourable effect of voucher scheme membership on the most vulnerable socioeconomic group remained significant after adjusting for educational status. The Bangladesh voucher scheme model has the potential to maximize gains in maternal and newborn health through enhancing the completeness of service provision.

Did the Consumption Voucher Scheme Stimulate the Economy? Evidence from Smooth Time-Varying Cointegration Analysis

Background: The stimulus coupon plan is one of the economic relief plans used to boost Taiwan’s slumping economy in the aftermath of the COVID-19 pandemic outbreak. In order to obtain prior information to understand whether or not the stimulus coupon plan would effectively revive the economy in advance, the purpose of this study is to learn lessons from Taiwan’s consumption voucher scheme initiated during the 2007–2009 global financial crisis through evaluating the effect of the consumption voucher scheme on private consumption expenditure. Methods: The smooth time-varying cointegration analysis was applied to estimate the income elasticity of consumption, indicating the individual’s reaction to consumption vouchers in terms of private consumption expenditure, and then the multiple structural change model was estimated to identify endogenous regime changes of the income elasticity of consumption. Results: We found that the income elasticity of consumption dramatically decreased after 2007Q1, a period that covered the subprime mortgage crisis in 2007–2009 and the time of issuance of the consumption vouchers in 2009. Conclusions: We concluded that Taiwan’s consumption voucher scheme might have had either no or little effect on stimulating the economy, so policymakers should be cautioned concerning the potential ineffectiveness of the stimulus coupon plan in the future.

Improvement of Elderly Health Care Voucher Scheme in Hong Kong

Elderly Health Care Voucher Scheme is a financial support provided by the government to the elderly for having more choices in selecting private primary health care services. It has been launched for more than ten years (including pilot scheme). The success of the voucher depends on its effectiveness so that Hong Kong elderly can benefit from it. The aim of this article is to analyse whether the voucher scheme has achieved its goals and what improvement can be made. The scheme is successful in encouraging the elderly to use private primary care, considering that the participation rate of the scheme is high, and elderly could use private health care services to supplement public health care services. Yet, the amount of the subsidy is insufficient to support the needs of the elderly and the providers of the voucher are not enough for Hong Kong elderly. Also, it is found that private health care services give the old generation an impression of expensiveness and unreliable even with the support of the Health Care Voucher. To improve the Elderly Health Care Voucher Scheme and solve the problems, the government should increase the amount of the voucher, set standards for regular monitoring, cooperate with private health care providers and invite more providers. Ultimately, the elderly would enjoy greater flexibility in choosing medical services in meeting their needs and the scheme can effectively achieve its purpose.

Does a non-targeted publicly-funded health care voucher system for the elderly improve access to optometry services?

ABSTRACTObjectiveTo study how a non-targeted publicly-funded health care voucher system for the elderly impact on access to optometry services from the perspective of service users and service providersDesignCross-sectional studySetting19 elderly community centersParticipants1176 people, aged 65 years or above, and 389 optometristsPrimary and secondary outcome measuresUsage characteristics of optometry services by eligible service users of the voucher schemePerspectives of eligible service users on access barriers to optometry servicesPerspectives of service providers on voucher schemeResultsIn total, 1156 valid questionnaires were collected from a cohort of eligible service users. Results showed that 53.7% of subjects had used optometry services within the past 2 years, while 22% had not used optometry services before. Lack of familiarity with services provided, professional fees and prices of prescription spectacles were the main barriers to using optometry services. Of those subjects who had used the voucher for optometry service before, 80.4% had eye examination in the past 2 years, versus 64.1% among subjects who had not use health care voucher on the optometry service. “Insufficient voucher value” was a commonly quoted reason for not using the health care vouchers for optometry services. Over 80% of optometrists agreed that the voucher scheme improved the awareness of major eye conditions and enabled the elderly to have prescription spectacles when necessary.ConclusionThe health care voucher for the elderly improved access to optometry services. Access could be improved further by promoting awareness optometry services, location of service providers, price transparency of professional services and prescription spectacles. Responses from optometry services providers are supportive of the view that the voucher scheme improved access to and utilization of preventive care services.Article SummaryStrengths and limitations of this study-High representativeness of community dwelling older population in Hong Kong.-The mixed method approach provided a more in-depth investigation of the population.-One limitation is the generalizability of the results with older people who are members in the community centers.