Economic Benefits of Universal Health Coverage for the Climate Induced Diseases in Southwest Coastal Region of Bangladesh: An Empirical Study Md. Hafiz Iqbal PhD Researcher Bangladesh University of Professionals (BUP) & Assistant Professor (Economics) Government Edward College, Pabna, Bangladesh E-mail: vaskoriqbal@gmail.com Human Well-being and Public Health 10 January, 2017 1
General features of low-lying coastal region of Bangladesh 1. Flat & low-lying topography 2. Vulnerability to climate change (salinity, SLR, drought, cyclones ) 3. Water logging / Drainage congestion / Salinity 4. Scarcity of pure drinking water & degraded soil 5. Seasonal food insecurity 6. Widespread poverty 7. Higher dependency on natural resources 8. Threatened for public health & human well-being 2
Outcomes Pathway framework: Exposure, outcome and controlling measure Exposure Climate change (Temperature, Salinity, Precipitation, Cyclone and Storm surge, Sea-level rise Indirect pathways Direct pathways Social-economic disruption Mental and physical well-being Crop yields Food insecurity Malnutrition Abundance of disease vectors Transmission dynamics Food-and waterborne disease Salinity Impure water and scarcity of drinking water Flood and Storm-related injuries and illness Stunted growth, morbidity, mortality Vector-borne disease Controlling Measure Water-borne disease/(pre) aclampsia UHC Every person, everywhere, has access to quality health care without suffering financial hardship 3
(Source: Prepared by the researcher, 2016) Health policy o Measure economic benefit of UHC o Meet the main goals of SDG o Meet constitutional demand o Implement perspective plan of Bangladesh 2010-2021 and vision 2021. o Fulfill the vision of Ministry of Health and Family Welfare o Developed specified policy to boost up our sense and notion Health for All. o BCCSAP gets important guidelines for its first pillar Food Security, Social Protection and Health WTP Management UHC R&D Human capability Stakeholders preference 4
RO1: Measure the willingness to pay (WTP) for provision of Universal Health Coverage (UHC) system RO2: Identify the determinants of Universal Health Coverage (UHC) RO3: Measure the economic benefits Research Objectives The general objective of this study attempts to explore the preference of the peoples of the low-lying southwest coastal region for different attributes on UHC by using discrete choice experiment method Four research objectives are work as the main building blocks of this research RO4: Develop an approach for the management strategy of Universal Health Coverage (UHC) for the people of the low-lying coastal region of southwest part of Bangladesh 5
Theoretical Motivation Stated Preference Approach (Stated preference methods assesses the value of non-market environmental goods by using individuals stated behavior in a hypothetical scenario) Conjoint Analysis (CA) Contingent Valuation (CV) Choice Experiment (CE) Advantage of CE -Minimizing strategic Bias -Useful for valuing a multi-attribute public good Utility derived from a good comes from the characteristics of that good, not from consumption of the good itself Lancasterian theory of value Random utility theory Direct & indirect determination of preference 6 is possible
The experimental design process Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 Problem Statement Stimuli refinement Alternative identification Attribute identification Attribute level identification Experimental design consideration Type of design Model specification (additive vs interactions) Reducing experiment size Generate experimental design Allocate attributes to design column Main effects vs interactions Generate choice sets Randomized choice sets Stage 8 (Source: Prepared by the auther, 2016) Construct survey instrument 7
Attributes and levels derived from FGDs Attribute Current levels Improvement levels Coinsurance for UHC/Year No measures 20% 23% 27% Telemedicine/Year No measures Highly Interested Moderate interested Low interested Medicare/Year No measures Disable Aged population Freedom fighter Social insurance/year No measures Highly Interested Moderate interested Low interested Medicaid/Year No measures Children under 6 Unemployed Poor people Payment for UHC/Year No measures 15% of progressive tax 17% of progressive tax 20% of progressive tax A full factorial design, which includes all possible combinations of attributes and levels results in 324 possible 6 combinations 3 3 3 3 3 3 3 729 using orthogonal design by SPSS. According to orthogonal design principle by using fractional design, we reduce it randomly to 18 for 6 versions of choice card and each version contains with three alternatives (options) including the status quo with replacement procedure. Each respondent answered twice. An example of choice task Option example Option A Option B Status quo Coinsurance for UHC/Year 23% 27% No change Telemedicine/Year Highly interested Low interested No change Medicare/Year Aged population Disable No change Social insurance/year Low interested Highly interested No change Medicaid/Year Unemployment Poor people No change Payment for UHC/Year 20% progressive tax 17% progressive tax No change Your choice (please tike one only) A B I would not want either A or B 8
Professional status Major disease pattern of household 6% 17% 24% 6% 26% 4% 5% 12% Farmer Bagger Day labor Small traders Service Unemployed Business Others 38% 5% 6% 7% 5% 33% 6% Diarrhoea Asthma Pneumonia Cholera Skin disease Eclampsia Malaria 9
Indirect utility model Multinomial logit model Random parameter logit model U ASC * puhc * cuhc * tm Ui pfuhc * puhc cuhc * cuhc tm * tm medai * medai i pfuhc cuhc tm si * si medca * medca medai * medai si * si medca * medca 1 ( ASC * inc) ( ASC * age) ( ASC * edu) ( ASC * hhs) 4 2 3 1 Compensating surplus(cs) ln exp( Uoi ) ln ( U1 i ) attribute Marginal willingness to pay(mwtp)= ( ) payment attribute 10
Definition of attributes and variables Attribute/Variable Definition ASC Alternative specific constant (1: the alternative with changes and 0: the status quo) cuhc Coinsurance for Universal Health Coverage (1: 20%; 2: 23% and 3: 27%) tm Telemedicine (3: Highly interested; 2: Moderate interested and 1: Low interested) medca Medicare (1: Disable; 2: Aged population and 3: Freedom fighter) medai Medicaid (1: Children under six; 2: Unemployed and 3: Poor people) inc Respondent s monthly income (Continues data) age Respondent s age (Continuous data) edu Respondent s educational level (Illiterate: 0, Primary: 1, Secondary: 2, Higher secondary: 3, under grade orgraduate: 4) hhs Respondent s household size (family size) 11
Model Multinomial logit model Random parameter logit model (Improved scenario case ) (Improved scenario case) Variables Coefficient Standard error P-value Coefficient Standard error P-value ASC 0.97201* 0.95653 0.0000 1.15809* 0.4509 0.0003 cuhc -0.31041* 0.0.585 0.0000-0.21099* 0.60451 0.0000 tm 0.99187* 0.18933 0.0000 1.45934*** 0.86770 0.0903 medai 0.72361* 0.09322 0.0013 1.40810* 0.39791 0.0000 si 0.50235** 0.11091 0.0420 0.17989** 0.21635 0.0400 medca 0.37019*** 0.39001 0.0701 0.59761** 0.10409 0.0503 hhs -0.53190 0.09306 0.1239 inc -0.61872 0.77098 0.2398 age 0.18119* 0.14795 0.0000 edu 0.89445* 0.0.078 0.0012 Log-likelihood -391.9070-225.4101 Pseudo R-squared 0.519087 0.430098 No. of observation (n) 417 417 Income: Mean=153,911 Standard deviation=21,589.652; Minimum value: 1300; Maximum value: 700000 Age: Mean=40.8565; Standard deviation=9.08847; Minimum value: 20 Maximum value: 70 Education level: Mean=1.17225 ; Standard deviation=0.9424; Minimum value: 0; Max. value: 4 Family size: Mean=5.13398; Standard deviation=1.52591 ; Minimum value: 2; Maximum value: 8 ***Significant at 1% (0.01), **Significant 5% (0.05), and *Significant 10% (0.10) 12
Marginal willingness to pay for the Attribute Attribute Coefficient Standard error P -value Coinsurance for UHC 0.890941 0.7501 0.0031 Telemedicine 0.450972 0.1320 0.0000 Social insurance 1.098453 0.9087 0.0000 Medicaid 0.673210 0.4309 0.0007 Medicare 1.009820 0.4500 0.0000 Estimation of welfare effects (economic surplus) Alternative improvement scenario WTP for the improve scenario Moderate scenario Tk. 870.904100 Upper scenario Tk. 1027.19842 Coastal people will pay for UHC to reduce out of pocket (OOP) expenditure during the catastrophic period 13
The message Preference based attributes of UHC can ensure good health and human well-being & protect coastal people from the climate induced diseases 14
Thank You all!!!? Question? Comments? Concerns 15