Socio-demographic Characteristics
Among the selected 828 households, finally 806 were interviewed in this study (97% response rate). These households consisted of 3,178 members, mostly adults (58.4%) followed by children (35.6%), and elderly (6.1%) (Table-1). The proportion of male to female was almost equal. More than half of these members were married. The majority of the members (47%) had no education, while 27.5% of had primary, and 25.5% had secondary or above education level. About 27% of the household members were housewives and around 15% were agricultural workers or day labors. Most of the households (58.6%) had 4-5 members, followed by less than 4 members (24.9%), and more than six members (16.5%). Around 36% individuals lived 15+ km away from the SSK facility while around 20% individuals stayed closer to the SSK facilities (less than 5km). More than one third of members belonged to the households having less than 10,250BDT (122 USD) income per month.
As per BPL household selection criterion, we found 66% of the SSK households were remained BPL at the time of interview. Regarding the knowledge of insurance scheme, about 68% of the visited SSK households knew about the SSK scheme. A higher proportion of beneficiaries (63%) knew about the service provision of SSK scheme, however, their knowledge about the benefit package of SSK scheme was found to be low. The majority (56%) of the beneficiaries reported of knowing about SSK scheme from the SSK representatives, followed by 25% from familiar people in locality, and 17% from relatives.
Utilization of healthcare
In the last 90 days recall period, almost 25% (n=781) of the surveyed individuals had self-reported illness or symptoms. Among the ill individuals, 81.8% (n=639) sought healthcare for their illness or symptoms from any types of healthcare providers. Only 8% of these individuals went to SSK facility for seeking healthcare. A large percentage (63.8%) of them went to ‘non-medically trained provider’. The majority of the individuals utilized healthcare from pharmacy (45.9%), followed by public providers (20.7%), and private providers (18.9%). Of the total ill individuals, 3.6% (n=23) utilized inpatient care (IPC) from any sources and only 10 of 23 (43.5% who required IPC)utilized IPC from SSK healthcare facility within 90 days prior to the survey.
While examining the utilization of SSK facilities by the background characteristics of the individuals, we found that the elderly (10.4%), male (7.2%), unemployed (12.1%), having primary level education (9.1%), having more than 6 members in the households (9.1%), had accident or injury (17.2%), and income level lower than 10,250 BDT (15.3%) and lived in 5 km or less distance from SSK facility (17.9%) had comparatively higher utilization from SSK facility compared to other corresponding groups. .
Healthcare seeking behavior
We found that, majority of the people utilized healthcare from the drug sellers (pharmacies) (45.9%). Among the respondents utilized healthcare from medically trained provider, 12.5% of them went to private/NGO hospitals followed by scheme facility (SSK UpHC), and general practitioner (7.5%), Medical college/specialized hospitals (5.5%), and other qualified providers (USC/MCWC) (2.7%).
While comparing the utilization by types of provider and types of reported illness, we found that 19.2% individual utilized SSK facility for accident/injuries while 34.6% from other MTP and 46.2% from non-MTPs.. Utilization from other MTP was the highest individuals who required female reproductive health and delivery services (76.5%) and had non-communicable diseases (47.2%). Utilization of non-MTP was the highest for communicable disease (66%), Accident and injury (46%) and for other illness (57%).
Associated factors of healthcare utilization from SSK facility
Table 4The utilization of health care from SSK facility were significantly associated with occupation, education, types of self-reported illnesses, knowledge of SSK scheme, living distance of health facility, and current BPL status of the household. We found that unemployed are about four times (OR: 4.175; 95% CI 1.01 - 17.24) more likely to utilize services from SSK facility compared to the agricultural/labor. Individuals having secondary or higher level of education were less likely to utilize healthcare from the SSK facility. Patients with accident and injury were almost five times more likely (OR: 5.11; 95% CI: 1.26 - 20.78) to utilize healthcare from SSK facilities than patients suffered from non-communicable disease. Member of households with 4-5 members were less likely to utilize healthcare from SSK facility compared to the households with less than 4 members. Individual who heard about SSK scheme were more likely to utilize healthcare from the SSK facility (OR: 10.61; 95% CI: 2.39 - 47.06). We observed that non-BPL household were above two times more likely to utilize healthcare from the SSK facility. Household distance of 15 km from the SSK facility were less likely to utilize healthcare from the scheme. We found that individuals from second income quintile were significantly utilized healthcare from the SSK facility compared to the poorest income quintile.
Associated factor of healthcare utilization from any medically trained provider (MTP)
Considering healthcare utilization status from any MTP (including SSK facility) as dependent variable, we found that having secondary and above level education were significantly associated with the MTP utilization compared to the no-institutional group. Similarly, people with self-reported injury and female reproductive problem utilized healthcare more compared to the people who suffered from non-communicable disease. Household size, knowledge of SSK scheme, BPL status and distance of nearest healthcare facility, and income quintiles didn’t have any association with the utilization of MTPs.