Bangladesh Government Embarks on Health Insurance

On the road towards implementing a health coverage program

The following article was published in The Daily Star, a popular daily newspaper in Bangladesh. Jahangir Khan, a Health Economist at icddr,b provides immediate reflections on this article in the comments

The government in a pioneering move has set to introduce health insurance program as an alternative health care financing for the country's 5 crore poor people from early next year.

Under the system, each of the poor would be given health insurance card to cover their medical expenses. The government will pay the insurance premium from general taxes as the insurance cost, according to the health ministry.

"We will form a taskforce to this effect this month (July). We would try our best to implement the health insurance program from early 2012," Prasanta Bhushan Barua, joint chief of the ministry's Health Economics Unit, told The Daily Star.

As part of the effort, the government delegates recently have visited some neighbouring countries where health insurance has been adopted successfully as an alternative health care financing.

Prasanta Bhushan was in the 15-member visiting team to watch the health insurance model in Bangkok, Hyderabad, and Delhi to verify the design, implementation process, and sustainability of health insurance programme in Bangladesh.

"Beginning with a pilot project for the 31 percent of the country's poor people, we would try to scale up for universal health coverage in phases," he said, adding that the first pilot project would begin soon in Rangunia of Chittagong and Debhata of Satkhira. The two upazilas are home to around 6 lakh people.

The socio-economic study would begin next month to find out the exact figure of the poor people in those localities, he said.

The ministry sources said the taskforce, headed by Health Minister AFM Ruhal Haque, would be the steering body for policy support and supervision of the total programme.

We should devise a way of our own to implement the programme, said the visiting team, adding that a combination of India's Rashtriya Swasthya Bima Yojna (RSBY) and Rajiv Arogyashri Health Insurance may suit for Bangladesh. The Thai model would be too costly to implement for this resource-poor country where per capita health expenditure is only $7.5, the team said.

The ministry initially thinks of providing secondary level health services along with some tertiary cares to the poor people under the alternative health financing. The people with health cards would be able to get treatment free of cost in listed public and private hospitals, they said.

Under the RSBY programme, people are provided secondary healthcares. Preparing a card spending Rs 30 only, a five-member family can get the insurance facility up to Rs 30,000 a year. Rajiv Arogyashri Health Insurance programme, however, covers primary to tertiary level health care.

Thanks to the government for

Thanks to the government for taking such a decision for developing welfare of people. The implementation of health insurance (mentioned above) involves all possible components (like, financing, healthcare providers, benefit package, smart card or similar one). The financing of this program in the long run must be important. Any interruption of the program (even after 5,...,10,...years) will create lack of trust. A sustainable funding method is thus essential.

Definition of “poor” needs to be clear and poor must be practically identifiable. We have national ID Card for all citizens at age of 18 years and above (not biometric). However, the information in national ID card can be scrutinized considering its applicability for using as ID Card for health insurance. In any case, we need something to do about people at age below 18 years.

“Informal sector workers” are not yet in the agenda of government’s insurance program. People in this category need to be included on the basis of some contribution to the total revenue of the program since they have the capability to pay something (how small it is!). We need more information collection and translation into knowledge and research in this regard.

I hope that at a certain stage of implementation (in near future), the government employees, self-employed, private sector works with formal employment can be included into health insurance on the basis of their financial contribution considering their ability to pay. It may create sustainable financing and cross-subsidization for including more people in health insurance.I feel that government already considering the issues described above.

Jahangir Khan

Very nice and informative

Very nice and informative blog. Thanks for sharing.


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