Page 21 - The Insurance Times June 2020
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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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