Health Financing Initiatives and Challenges in Bangladesh

Health Economics UnitMinistry of Health and Family Welfare

Objectives and expectations

❶ Sharing of different government initiatives in the area of health financing

❸ Garner support for implementation of the initiatives included in the HCF Strategy and its spirit of access, equity and efficiency

❹ Identify possible roles of different stakeholders in implementation

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Health financing Mechanisms in Bangladesh

The Health Care Financing Strategy 2012-2032

www.heu.gov.bd

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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 health② Improving equity in health financing ③ Improving access to essential health services④ Reducing the incidence of impoverishment

due to catastrophic health care expenditures ⑤ Improving quality and efficiency of service

delivery.

Population coverage plan in HCFS P

OP

UL

AT

ION

151

.6 M

ILL

LIO

N (

2012

)

Below Poverty Line 31.5% 47.8 MILLION 83.4 MILLION 20.5 MILLION Formal; regular income 13.5%

Poor Tax-funded publicly financed health care Non-contributory health protection scheme (e.g.

SSK)

S

OC

IAL

TR

AN

SF

ER

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

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7

1. COVERAGE – Progressive Approach during System- Building Phase following common guiding principles and design elements

Enactment of SHI LawEnactment of SHI Law

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2. IMPLEMENTATION PLATFORMS

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.

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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 cross-subsidization

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

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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

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U H C

O P D

Consultation

SSK BoothHousehold

D H

A Benefit package of 50 diseases including diagnosis and drugs as per

defined treatment guidelines

Transport cost

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

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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

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BPL HH

SSK Cell

S O

U H C

D H

GoB/DP

Financial management of the Scheme

Prem

ium

for

BP

L HH

Allocate

fund

Issue Health Card

Treat patients as per guide lines

Des

ign

Ben

efit

Pac

kage

Structured referrals

Claim forms

Claim forms

Reimbursed

Reimbursed

Feed back

Management fees

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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 labourer② landless household  owning homestead only and no other land③ 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

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Grievance Mechanism

❶ An independent grievance mechanism to be established through an executive order of GoB

❷ SSK members/beneficiaries will have right to complain① poor quality of services ② lack of drugs③ unofficial payments④ Other related issues

Grievance authority① accessible for SSK members at local level (UHC)② will have the power to initiate inspection and sanctions

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SSK, Formal &Informal sector coverage

Single fund Efficiency

SolidarityRisk-adjusted resource

allocations

Poolin

g

Effectiveness

Allocation AllocationAllocationContribution Contribution Contribution

Reso

urc

e

colle

ctio

n

Formal sector

Income related payments

Employer Employee

Subsidy

TaxesInt. buyer

Govt employees

Private formal sector, RMG,BRAC

Mem

bers

hip

acc

ord

ing

to

pro

fess

ion MHI NGO

Union …

Com

peti

tion

Informal sector

Income related

payment

Employee (sliding scale)

National grants

Financed through remittance levy (0.5 %)

SSK

Below poverty line

National grants

Financed through (general / earmarked) taxation

Guiding Principles

Legislation on Social Health Protection

❶ Legal base for implementing social health insurance/ protection schemes

❸ Provide institutional framework for financial and service delivery issues

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Thanks