Health Financing
Moving towards universal health coverage
Although Bangladesh has made significant progress on health-related MDGs, the country is now facing challenges like high and impoverishing out-of-pocket health spending; an increasing burden of high-cost non-communicable diseases superimposed on an unfinished health agenda of preventable and communicable diseases. In order to tackle the challenges, appropriate strategy for national healthcare financing to move towards universal health coverage is crucial. Universal health coverage (UHC) in countries of South-East Asia Region of the World Health Organisation (WHO) is based on three strategic choices: (a) priority populations to be covered; (b) essential or basic package of services to be delivered; and (c) cost subsidies to be provided Out-of-pocket spending (OOP) to access healthcare causes inequities in health and is a lead cause of household poverty. In South-East Asia, out-of-pocket spending contributes over 60% of total health expenditure and is the cause of one-third of annual new poverty. Countries that have made progress towards UHC have reduced out-of-pocket spending to less than 30% of total health expenditure and increased government spending to over 4%. Experience has shown that there are inequities that could be avoided by pre-payments and social pooling of resources — general government revenues are the most equitable form of health financing. Mandatory and contributory social insurance is the next option. Where there is limited scope to increase fiscal space for health and where the formal sector too is limited, a practical way forward is to improve the efficiency in the current use of public resources; use innovative financing in the short-term for targeted population/services; and initiate contributory schemes as a supplementary measure. Shifting away from fee-for-service to capitation and case mix payments methods has improved provider performance in the public sector and also aligned the private sector to universal health care efforts. Strong government leadership and increasing institutional capacity are crucial to move towards universal coverage.
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