Health Financing Initiatives and
Challenges in Bangladesh
Health Economics Unit
Ministry of Health and Family Welfare
Objectives and expectations
❶
❸
❹
Sharing of different government initiatives in
the area of health financing
Garner support for implementation of the
initiatives included in the HCF Strategy and its
spirit of access, equity and efficiency
Identify possible roles of different stakeholders
in implementation
2
Health financing Mechanisms
in Bangladesh
•Unaffordable
by majority
•Risk-Adjusted
Premiums
•Inequitable
•Covers less
than 1% of
the population
•Targeted
towards low
income
urban/rural
•Unsustainable
•High drop-out
rates
• increased significantly
from 2008 to 201193% of DHs and 48%
of UHCs reported
collecting some user
fees(BHFS 2012)
Private
Health
Insurance
Micro
Health
Insurance
User Fees
Govt.
Funded
Health
Care/NGOs
•Public Health
Facilities
provide free
care to all
population
•DSF SchemeMaternal
Health
Vouchers, P4P
•Urban Health
The Health Care Financing
Strategy 2012-2032
Expanding Social Protection for Health:
Towards Universal Health Care Coverage
Health Care Financing Strategy 2012-2032
www.heu.gov.bd
4
Health Care Financing Strategy
(2012-2032)
❶ The Health Care Financing Strategy provides a
framework for developing and advancing health
financing in Bangladesh.
❷ The framework and its direction are aimed at:
① Increasing the level of funding for health
② Improving equity in health financing
③ Improving access to essential health services
④ Reducing the incidence of impoverishment
due to catastrophic health care expenditures
⑤ Improving quality and efficiency of service
delivery.
Population coverage plan in HCFS
83.4 MILLION
20.5 MILLION
Formal; regular income
13.5%
Informal sector
 Tax-funded publicly financed health care with
user fee retention
 Community-based health insurance initiatives
 Micro health insurance
 Other innovative initiatives
 Gradual move to Social Health Protection
coverage
Formal sector
 Tax-funded publicly financed health care with
user fee retention
 Social Health Protection scheme
 Complementary private coverage
SOCIAL TRANSFER
POPULATION 151.6 MILLLION (2012)
Below Poverty Line 31.5%
47.8 MILLION
Poor
 Tax-funded publicly financed health care
 Non-contributory health protection scheme (e.g.
SSK)
6
Assessment &
Fine-Tuning
Initial Phase (20142017)
(2018)
Scale-Up
(20192020)
Nationwide
Implementa
tion (2021
onwards)
1. COVERAGE – Progressive Approach during System- Building Phase
following common guiding principles and design elements
Formal
Sector
18.8 M
(12.3%)
• Civil Servant
Scheme
• Ready Made
Garment
Scheme
Informa
l Above • Micro-insurance / CBHI
Poverty • Private Insurance
Line (APL) • Tax Funded public
85.7 M
(56.2%)
Below
Poverty
Line
Evaluation
and FineTuning
Unified
SHI
Scheme
health services
• SSK Scheme
• Tax Funded public
health services
48 M
(31.5%)
Enactment of SHI Law
7
Initial
Phase
(20142017)
Assessment
& FineTuning
(2018)
ScaleUp
(20192020)
Nationwide
Implementation
(2021 onwards)
2. IMPLEMENTATION PLATFORMS
Policies and Frameworks
(Legal, Regulatory, and
Financial)
• Draft SHI Law, Approval process and
IRR
• User fee retention; provider
autonomy
Organization
• HCFS Advisory Council and HCFS
Coordination Team
• New autonomous body and its office
Communication
• Key Stakeholders- political, internal,
CS and public
• Marketing Plan
Capacity Development
•Individual, organizational capacities
(outsourcing of studies and researches)
•financial management, contracting,
statistical analysis, marketing, SHI
management
Health System Efficiencies
•Quality assurance and accreditation
system, IT system, expansion of DSF
•Procurement of drugs, adequate and
motivated HR, needs-based resource
allocation
Monitoring and Evaluation
•Regular reporting and monitoring;
registration and monitoring of micro
insurance; evaluation of schemes and
fine-tuning
•Impact monitoring by independent body
8
Objectives of the scheme
❶ Improve access of the poor to hospital inpatient care by
reducing financial barriers
❷ Protect poor people from catastrophic payment for
treatment
❸ Increase the authority at hospital level for functional
improvement as a part of Local Level Planning (LLP) and
development.
❹ Introduce performance based financing models.
10
Overview of SSK
❶ Innovative health protection scheme to be Piloted in 3
upazilas
❷ Targeted to Below Poverty Line (BPL) households initially
❸ Fully subsidized (govt. will pay the premium)
❹ Later, APL households will be included in the scheme as
paying members for sustainability, risk pooling and crosssubsidization
❺ Initial stage Tk. 1000 per household per year as premium
❻ Household can get treatment benefit up to Tk 50,000 per
year
❼ Support from KfW
11
Service Delivery
Health card (paper based / smart card) per household
A benefit package of treatment for 50 diseases including drugs
and diagnosis according to defined treatment guidelines
Initially Public Health Facilities (Upazila Health Complexes and
District Hospital) will provide the services
Gradually includes private facilities under an accreditation plan
UHC as the focal point of service delivery with a SSK booth at
the hospital
Structured referral to DH (UHC as the gate keeper)
Service delivery
Household
UHC
SSK Booth
Consultation
OPD
A Benefit package of 50 diseases
including diagnosis and drugs as per
defined treatment guidelines
DH
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Management of the Scheme
❶ SSK Cell at centre and coordinators at field
❷ Engagement of Scheme Operator as management
agency
❸ Grievance procedure
❹ Introduce modern IT (in claims processing, accounting,
controlling, and electronic patient records) for increased
efficiency and transparency
❺ Supervision and guidance from Inter-ministerial Steering
Committee led by Hon’ble Health Minister and Working
Committee headed by Secretary MOHFW
14
Financial management of the Scheme
❶ SSK Cell will receive the premium from the Government (DP)
❷ It will allocate an amount to the Scheme Operator (SO)
❸ Hospital will treat the SSK patients according to the standard
guidelines
❹ It will claim reimbursement to the SO based on the
designated price of the benefit package
❺ SO will review the claim and disburse the money to the
hospital
❻ SO will get fix management fees
15
Financial management of the Scheme
Treat patients as
per guide lines
GoB/DP
BPL HH
UHC
SO
SSK Cell Management fees
DH
16
Identification & Registration of BPL
Population
❶ BPL identification & registration will be started soon
❷ Eligible poor for SSK scheme would be those satisfying any 2 of
the 3 criteria which includes:
①
main earning person or head of family is a casual day labourer
②
landless household owning homestead only and no other land
③
household have no permanent/regular income source
❸ Organize sensitization campaign at pilot sites, and
❹ Decide the process of identification & registration consulting
with local administration
17
Grievance Mechanism
❶ An independent grievance mechanism to be established
through an executive order of GoB
❷ SSK members/beneficiaries will have right to complain
① poor quality of services
② lack of drugs
③ unofficial payments
④ Other related issues
Grievance authority
① accessible for SSK members at local level (UHC)
② will have the power to initiate inspection and sanctions
18
Solidarity
Efficiency
Effectiveness
Allocation
Contribution
employees
Income related
payments
Employer
Employee
Membership
according to
profession
Govt
Private
formal
sector,
RMG,BRAC
Subsidy
Taxes
Contribution
Allocation
Allocation
Informal sector
Formal sector
Resource collection
Risk-adjusted resource
allocations
Single fund
Int.
buyer
MHI
Union
Income
related
payment
Employee
(sliding scale)
NGO
…
Contribution
Below poverty line
Competition
Pooling
SSK, Formal &Informal sector coverage
National
grants
Financed
through
remittance
levy (0.5 %)
SSK
National grants
Financed through
(general / earmarked)
taxation
Guiding Principles
Uniform
base
benefit
Choice of
providers
Portability
of
benefits
Obligation
to
contract
Family
membership
Legislation on Social Health Protection
❶
❸
Legal base for implementing social health
insurance/ protection schemes
Provide institutional framework for financial
and service delivery issues
22
Thanks