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Health insurance for all by 2032?

Govt embarks on ambitious 20-year scheme; financial details not clear yet

Porimol Palma
In a major move to reform the country's health sector, the government has taken up an ambitious plan to bring all citizens under national health insurance coverage by 2032.
The plan envisages quality healthcare for all without financial hardship to any, say officials of the Health Economics Unit (HEU) of the health and family welfare ministry.
"The first target will be people below the poverty line, some 48 million now. The
government will pay their premiums as subsidy," HEU Director General Ashadul
Islam has said.
For this programme, the HEU has designed the Healthcare Finance Strategy 2012-2032. And the government is now drafting a law.
However, the government is yet to come up with details of how it will finance health insurance for the entire population.
The scheme will be mandatory for those having regular jobs in the formal sector. They will pay premiums but the govern-
ment might provide partial financial support depending on their income, the HEU director told The Daily Star recently.
People in the informal sector or those having no regular jobs and income may voluntarily join the scheme. For their insurance coverage, they could be given incentives based on their financial status.
"The health insurance will not necessarily cover treatment of all diseases, but it will ensure everyone gets certain health services, like the treatment of most common diseases."
Before the launch of the insurance programme, a four-year scheme, Shasthyo Suroksha Karmashuchi (SSK), will be run as a test case in Kalihati, Madhupur and Ghatail upazilas of Tangail from the end of the year.
Under the scheme, free health cards will be issued to around one lakh households living below the poverty line. If one falls sick and shows the card to the SSK booth at the upazila health complex, one will get treatment either at the complex or at the district sadar hospital.
“This scheme will cover the treatment of 50 most common diseases," said Ashadul Islam. For each
household, the government will payTk 1,000 as annual premium.
The health ministry is also working with the German cooperation agency GIZ to start a social insurance scheme for readymade garment workers in January next year with contributions from workers, employers, buyers and the government.
The lessons learned from these pilot projects will be applied to determine the exact mode of operation of the nationwide health insurance scheme.
Ashadul Islam said the health ministry had targeted raising the health budget to 15 percent of the
national budget by 2032. It is now less than 5 percent.
"Gradual increase in government allocation for health, earmarked tax from tobacco, premiums from insured and foreign funds will help increase the health budget," he added.
As part of health sector reform, the government will establish a Social Health Protection Scheme (SHPS) by 2016 to financially protect all sections of the population. It will have a fund with resources from both internal and external sources.
Besides, a National Health Security Office (NHSO) will be established to manage funds, set premiums of insurance and prices of healthcare.
These moves come at a time when people spend 64 percent of total health expenditure out of their own pockets. As a result, some 15 percent house-
holds are left economically vulnerable.
Less than one percent people are covered by health insurance, which they buy on their own, according to HEU statistics.
The public hospitals provide low-cost subsidised healthcare, while treatment at the dominant private sector is quite expensive. Except for certain institutions, quality of both the sectors is questionable.
"The idea of social health insurance is that all will pay, but those getting sick will benefit," said Paul Rueckert, health management expert of German cooperation agency GIZ, which is providing technical cooperation in the health insurance programme.
If hospitals come under contracts with insurers, healthcare of a certain quality will be maintained, he said. The rich, who might want extra facilities, will pay beyond what is covered by
the insurance.
However, government-provided preventive services like immunisation, maternal and child healthcare will have to continue, added the health expert.
Ahmad AN Neaz, public health professor at American International University of Bangladesh, lauded the national health insurance plan but emphasised producing skilled doctors, nurses and health technicians.
Professor Syed Masud Ahmed of Brae University thinks mobilising funds for the plan will be a great challenge. He has suggested the authorities create mass awareness to make the initiative a success.
“If there are good examples proving that people really get quality services through the scheme, the idea can be expanded fast,” he told The Daily Star.