BANGLADESH: Health System Financing- Overview & Critical Analysis

Summary

This presentation provides a critical analysis of Bangladesh's healthcare financing system, highlighting the country's epidemiological and demographic transitions. Despite the government's efforts to subsidize healthcare, citizens bear a heavy burden of out-of-pocket payments. The system is highly centralized, and access to care is limited in rural areas. The analysis discusses the regressive nature of health financing, widespread corruption, and inequities affecting the poor. Recommendations include increasing public expenditure, decentralizing healthcare management, and implementing progressive taxation reforms to create a more equitable system based on the Beveridge model.

Takeaways

• 🌍 Bangladesh is a densely populated South Asian country with a GDP of over 302 billion USD and a population of over 163 million.
• 📈 The country is undergoing epidemiological and demographic transitions and was reclassified as a lower-middle-income country in 2015.
• 🏥 The 1972 constitution guarantees basic medical care for all citizens, but in practice, healthcare is heavily subsidized by the government with significant out-of-pocket payments required.
• 🔄 Bangladesh's health system is pluralistic, involving government, non-profit, for-profit, and international organizations, with the Ministry of Health and Family Welfare as the central authority.
• 🏥 The health system is highly centralized, with primary care available nationwide but secondary and tertiary care limited to certain areas.
• 💸 The main sources of health financing are out-of-pocket payments, government schemes, foreign aid, voluntary private, firms, non-profit and NGOs, and voluntary insurance schemes.
• 📊 Out-of-pocket payments constitute a large portion of health financing, at 67% in 2015, compared to 23% government financing.
• 🌐 The total health expenditure as a percentage of GDP was 2.98% in 2015, with private sector expenditures making up 77.26% of the total health expenditure.
• 💼 The health financing system is complex, with many funding sources and intermediaries, and is heavily reliant on indirect taxation, which can be regressive.
• 📉 Health expenditure decreases as you move from the lowest to the highest income quintile, indicating a regressive system where the poor bear a higher burden.
• 🔄 Recommendations for improvement include moving towards a Beveridge system, increasing public expenditure, improving tax effort, and enforcing wealth tax, as well as decentralizing decision-making and increasing transparency to reduce corruption.

Q & A

What is the current GDP of Bangladesh?

Bangladesh has a GDP of over 302 billion US dollars.

When was Bangladesh reclassified to lower middle-income status?

Bangladesh was reclassified to lower middle-income status in 2015.

What are the demographic and epidemiological transitions Bangladesh is experiencing?

Bangladesh is in the middle of an epidemiological and demographic transition, which is significant for its health systems financing.

What does the 1972 constitution of Bangladesh affirm about healthcare?

The 1972 constitution affirms that all citizens are entitled to basic medical care.

How is the healthcare financial system in Bangladesh described as inequitable?

The healthcare financial system is inequitable due to high levels of out-of-pocket payments, which are more concentrated among the poor.

Which are the main actors in Bangladesh's pluralistic health system?

The main actors in Bangladesh's health system are the government, non-profit, private for-profit, and international development organizations.

What is the role of the Ministry of Health and Family Welfare in Bangladesh's health system?

The Ministry of Health and Family Welfare is the central body that governs public and private health sectors and manages policy and pharmaceuticals.

What are the six main sources of health financing in Bangladesh?

The six main sources of health financing in Bangladesh are out-of-pocket payments, government, foreign, voluntary, private firms, non-profit and NGOs, and voluntary insurance schemes.

What percentage of health expenditure in Bangladesh is covered by out-of-pocket payments?

In 2015, out-of-pocket payments accounted for 67 percent of health expenditure in Bangladesh.

How does the health financing system affect the poorest citizens of Bangladesh?

The health financing system is highly regressive, meaning the poorest citizens bear a greater financial burden, which can lead to issues like selling belongings, inability to maintain nourishment, dropping out of school, medical debt, and bankruptcy.

What recommendations are made to improve the health financing system in Bangladesh?

Recommendations include progressing towards a Beveridgean system, increasing public expenditure, improving tax effort, enforcing a wealth tax, decentralizing health system management, adding medical ethics to curriculums, and using government funds to subsidize healthcare professional education in rural areas.