Piloting a Social Health Insurance Scheme among the Rural Hard Core Poor: What needs to be considered?

Presenter: Azaher Ali Molla, University of Dhaka

Abstract

Rationale: At present, there is an urgent need to find alternative means of healthcare financing, so that poor households can have access to modern healthcare interventions. Health care systems in Bangladesh are currently undergoing reforms, and the challenge now is to harmonise the three inter-related functions of health financing, i.e., collection of revenue, pooling of financial resources, and purchasing of interventions. It is also essential that the health systems protect the people financially in the fairest way possible, and that appropriate incentives are given to health care providers to motivate them to improve the health of the people by improving the responsiveness of the system.

Objectives: To initiate a health insurance pilot scheme among the hardcore rural poor, the Health Economics Unit of the Ministry of Health and Family Welfare, Government of Bangladesh with the technical and financial assistance from World Health Organization, Dhaka Office has undertaken this baseline study to collect data on household expenditure and willingness-to-pay for health insurance. The specific objectives were, a) to measure the household asset status; b) to assess the illness pattern of the households; c) to estimate the costs of treatment related to each illness including the costs of medicine, doctor’s fee and transport costs; and d) to assess the willingness-to-pay for the insurance with mode of payment.

Methodology: The study population was comprised of poor households in all the selected 5 out of 8 unions, the lowest public administrative system. Two criteria were used to locate the poor households. Firstly, the vulnerable group feeding (VGF) card holders developed by World Food Program, and secondly, the zero tax payers. As all the zero tax payers were the VGF card holders, so we consider all the VGF card holders as our population. The lists of VGF card holder were collected from all the 5 unions, and applying a systematic random sampling the sample households were identified.

Findings: The findings included socioeconomic status of the households including their income and expenditure pattern, disease incidence and prevalence, costs of treatment and willingness to pay for the insurance. Costs of treatment vary from disease to disease; BDT 34 (US $ 0.50) for a simple fever, BDT 50 (US $ 0.74) for cold cough and BDT 65 (about US $ 1.00) for gastric pain. Among the respondents, only 9% heard of health insurance and among them 56% were willing to pay upfront.

Conclusion: The study among the hard core poor is a first of its kind and the findings will be used for future planning in initiating a health insurance scheme in rural Bangladesh. Variables like prevalence and frequency of disease and costs of treatment may be used to fix up the premium of health insurance.