Wallet-emptying healthcare seeks resolve through insurance

As people are being reduced to destitution trying to meet medical expenses, resolution through insurance could be a wayout, expert said.

A staggering 79 percent of healthcare costs come directly from individuals' own pockets—one of the highest rates in the world. Even a minor illness pushes people towards poverty, making the poor even poorer. And, those above the poverty line seem to be in a precarious position, as if they could fall with a nudge, just to cover medical bills. The increase in non-communicable diseases now threatens the gains made in average life expectancy.

Despite a per capita GDP of $2,600, government spending on health is only USD 53 per person. Hypertension, diabetes, and cancer are rising at an alarming rate. Food adulteration and trans-fats further increase the risks. Meanwhile, the overuse of antibiotics is reducing their effectiveness, creating a new major threat to healthcare. At the same time, road accidents are increasing disability and family burdens.

To overcome the situation, the government is currently seeking a solution in health insurance, alongside several other initiatives. These issues have been highlighted in the five-year strategic framework prepared by the General Economics Division (GED) of the Planning Commission, a government body. The goal is to reduce out-of-pocket healthcare expenditure to below 50 percent. To this end, a national social health insurance scheme is being introduced as part of universal health coverage. To strengthen primary healthcare, 14,000 community clinics will be reinforced. By 2031, more than 200,000 health workers will be recruited.

However, public health experts and analysts say that implementing health insurance is not easy. The insurance sector in the country is already in a fragile state. Implementing this initiative requires well-thought-out planning.

The GED states that there is no alternative to universal integrated health protection to solve the problems, and the government is moving in that direction. Because the epidemiological transition, the burden of communicable diseases, the rapidly growing non-communicable diseases, the resurgence of measles, and the declining trend in total fertility rates are exposing weaknesses in the health sector. Currently, the country's average life expectancy is 73 years, which is higher than the regional average; but this achievement is under threat due to the rise in non-communicable diseases.

Dr. Zahid Hussain, former Lead Economist at the World Bank Dhaka office, told Agamir Somoy: "Health insurance is very important. There is definitely a need for it, that goes without saying. Since financing is a major issue in ensuring health security, having an insurance system would be good. But the question is—who will do it and how? Will it be done by the government, the private sector, or individuals acting alone, or jointly? Besides, our insurance industry is already in a state of disappointment. Private insurance companies themselves are not in good health. Under such circumstances, introducing health insurance requires careful planning. In particular, the experiences of countries like ours around the world could be useful."

The framework states that if first-line antibiotics stop working, then every surgery, every common complication, every tuberculosis treatment, and every case of childhood pneumonia will become more difficult and expensive to manage. In addition, although food safety is important, the health sector has historically neglected it—even though the government has spent hundreds of crores of taka on it. When one-third of food is adulterated, it is not possible to bring child stunting down to 15 percent. Since most cooking oils contain trans-fat levels four times higher than the prescribed limit, the epidemic of non-communicable diseases cannot be controlled. Antibiotic residues spread uncontrollably from farms to dining tables, making it difficult to control antimicrobial resistance.