Page 21 - The Insurance Times June 2020

using up liquid savings, informal borrowing, even disposing a benefit package has been designed. Premium calculation
of productive assets and the like to manage the treatment has also been done simultaneously and in a manner
cost. However, more recently reliance on microcredit has congruent with the standard actuarial practices. Therefore,
expanded greatly, but such avenues do not offer a great deal Health insurance is required to address all the challenges in
of scope for risk mitigation to the community of Bangladesh. Bangladesh related with Health and medical treatment.

In addition, some ex-ante activities (e.g., income diversification Methodology:
and investing in lower risk assets) may themselves increase the We have applied two methods to conduct the research:
risks of future poverty (i.e., vulnerability), while the ex-post
(i) Household census to identify below poverty line (BPL)
strategies (e.g., disposing of productive assets) may lead to
households and verification of list of poor (SSNP
persistent or deepening poverty.
beneficiaries) endorsed by LGIs, and
In the absence of well-targeted safety net measures, poorest (ii) Household survey for assessing health seeking behavior,
end up relying largely on self-insurance devices to mitigate health care expenditure, willingness to pay and patient
risks with high implicit premiums. Several authors have satisfaction.
proposed that microinsurance products (e.g., life, health &
livestock) if suitably designed would go a long way in The study has covered randomly few selected areas of
preventing the risks of further poverty (Ahsan, 2009; Dror, Shastho Shuraksha Karmasuchi, (an Initiative of Ministry of
2007 and Morduch, 2006). Through various reports, we have Health and Family welfare of Bangladesh) , of to carry out
found that health is the dominant category of shocks the pilot project using probably sampling approach. For rural
experienced by the poor in Bangladesh and annually areas, villages were selected as primary enumeration units
households spend about five per cent of total expenditure at Kalihati,Ghatail ,ModhupurUpazila of Tangail District. The
to meet out-of-pocket (OOP) health care expenses (Ahsan household census covered 10,000 households in primary
et al., 2012, 2013a). enumeration areas., while household survey involved 3000
randomly selected households.
We have also noticed that there is also evidence that OOP
payments push over three per cent of the households into The study made use of six different types of data collection
poverty annually according to the report of (Hamid and instruments like poor household identification format,
Ahsan, 2013). Thus, countries like Bangladesh need to start household interview schedule, exit patient interview
afresh with innovative means of raising funds for the provision schedule, key informant interview check.
of health care. Micro Health Insurance (MHI) is one such
innovation, which relies on pooling the risk as well as the Progress of Bangladesh Health Scenario
available resources for the provision of affordable care.
Over the past 47 years since independence Bangladesh has
made lot of strides in the Health sector which is clearly
Lack of quality provision of care plagues many micro health
visible. The major developments have taken place in
initiatives, and to this end which can provide a large range establishment of medical colleges, medical university,
of services, both in-and-outpatient including emergency, to private medical colleges, private clinics, private hospitals,
the poor of the region. district hospital, rural health centers and community clinics
in various parts of the country to provide easy access to
Drug costs, as is well-known, remain the main challenge in health treatment.
designing an affordable premium in MHI schemes, and in
order to contain the same, socially committed
pharmaceutical companies have been integrated into the
pool of partners.

Benefit package design and its pricing (i.e., the insurance
premium) are the other facets of this process. Based on
extensive analysis of provider's services and fees, the pattern
of morbidity of the target population, health seeking
behaviour and of the sources of burdensome out-of pocket
(OOP) health expenses faced by the rural poor in Bangladesh,

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