Health Financing Initiatives and Challenges in Bangladesh Health Economics Unit Ministry of Health...
Transcript of Health Financing Initiatives and Challenges in Bangladesh Health Economics Unit Ministry of Health...
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 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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1. COVERAGE – Progressive Approach during System- Building Phase following common guiding principles and design elements
Enactment of SHI LawEnactment of SHI Law
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
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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