Experts at a seminar have called for making the health insurance mandatory in the country, saying that voluntary micro health insurance scheme has been proved ineffective in Asian countries.
They also said the overall trend of health sector is on the decline even as the out-of-pocket (OOP) expenditure was supposed to decrease as per the Health Financing Strategy (2012-2032).
The OOP has increased to 67 per cent in 2019 from 63 per cent in 2012 although the Health Economics Unit (HEU) has prepared the health financing strategy to achieve the goal of universal health coverage (UHC) by reducing the OOP to 32 per cent by 2032, they said on Sunday.
The Institute of Health Economics (IHE) of Dhaka University and HEU of the health ministry organsied the seminar on 'Future of Health Insurance in Bangladesh' at CIRDAP auditorium in the city, with health services division secretary Ashadul Islam as the chief guest.
The experts suggested initiating a discussion on health insurance in parliament, narrowing down the gap on the concept of universal health coverage (UHC) between the DG health and health economics unit (HEU) and shifting from the present input-based budget for the Shasthya Surookha Karmosuchi (SSK) to output-based budget to promote health insurance.
They also laid emphasis on the need to establish good governance in the health sector and improve service quality.
The private insurance companies should also shun the profit-maximisation attitude, they added.
In his presentation, IHE Professor Syed Abdul Hamid said the government's target is to raise contribution of insurance to 4.0 per cent of GDP by 2021 from 0.9 per cent at present -- 0.7 per cent in terms of life insurance and 0.2 per cent non-life insurance.
The size of the current health insurance market is only 20,000-25,000 clients with an accumulated premium of about Tk 250 million.
Of the total market, individual voluntary health insurance is 10 per cent and group health insurance 90 per cent.
The major players are -- Green-Delta (20-25 percent of the market share of GICs), Reliance, Pioneer and Prime.
Touhidul Islam, World Health Organisation (WHO) national professional officer in health financing, said that health insurance cannot be successful here without the readiness of supply side of the government.
There must be adequate number of doctors, medical supplies and equipment combined with good governance, he added.
He suggested that the insurance companies must shun the profit-maximisation attitude so that people can enjoy the benefit of health insurance.
Annually, 5.0 million people fall in poverty due to excessive OOP in Bangladesh, he said.
As per Household Income and Expenditure Survey (HIES) 2016, only 15.85 per cent of people who needed healthcare received health services from public facilities.
AS per HIES 2010, government providers (doctors and health workers) served 11.69 per cent of population in public facilities who needed services. On the other hand, government doctors served 14.34 per cent of population in private facilities.
Ashadul Islam said the government has been discussing the health insurance issue for a long time without any result.
DG HEU Shahadat Hossain said it will be difficult to achieve the SDG targets in health sector if things continue like this.
There are various targets for 2020, 2025 and 2030. The country is already behind the target of 2020, he added.
Adequate number of doctors and medical supplies like medicines and equipments should be ensured first to make health insurance programme a success, he said.
It is not possible to provide health insurance for all at the moment, said the HEU DG, adding: "It should be implemented step by step."
"We can introduce health insurance for the people living below the poverty line (31 per cent of the population) and formal sector employees first. The government can use the medical allowance as the premium," he said.
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