Abstract

Abstract

Amid the COVID-19 pandemic, Bangladesh has realized the need for health insurance once again. Changing disease patterns and global economic shocks, such as the Russia-Ukraine war, enhance the cost of living and healthcare expenses, thereby reducing access to healthcare services for many households. Low healthcare coverage from the public sector has resulted in a high burden of out-of-pocket (OOP) expenditures, which account for 68.5% of total healthcare expenditures in Bangladesh. In this context, Community based health insurance (CBHI) has emerged as a potential alternative for improving financial protection and advancing progress toward Universal Health Coverage (UHC). The study examines the willingness-to-join (WTJ), a hypothetical CBHI scheme, and identifies the determinants influencing enrollment among rural households in the Gaibandha district of Bangladesh. A survey was conducted among 516 randomly sampled respondents. The study found higher acceptance: 90.1% agreed to join, and 86.2% were willing to pay the proposed premium for the hypothetical CBHI scheme, with a mean value of Bangladesh Taka (BDT) 97.34. The study identified several factors significantly associated with WTJ, the scheme, including family size, annual outpatient expenditure, distance from the hospital, choice scheme, and trust in the implementation committee. However, awareness of CBHI was extremely limited, with 97.1% of respondents reporting little or no prior knowledge of the scheme. Furthermore, a large majority (96.7%) expressed a preference for government involvement in managing the scheme. The findings suggest that awareness creation campaigns and institutional support are essential for the successful implementation of such a scheme.