Designing an Health Insurance Scheme for Government Employees in Bangladesh: A Concept Paper

Introducing compulsory health insurance for government employees bears immense importance for stepping towards universal healthcare coverage in Bangladesh. Lack of scientific study on designing such scheme, in the Bangladesh context, motivates this paper. The study aims at designing a comprehensive insurance package simultaneously covering health, life and accident related disability risks of the public employees, where the health component would extend to all dependent family members. We mainly analyzed, due to lack of data on the target population for actuarial calculation, the MIS data of group health insurance schemes (offered to various corporate houses) of some reputed insurance companies in Bangladesh. In addition, we consulted with various stakeholders including insurance companies and Insurance Development and Regulatory Authority. Our predicted loading costs including inflationary factor ranges from 10-15 percent. We have outlined the structure of a contributory and cashless health insurance scheme for the public servants and their eligible family members initially for a block period of 5 years. This offers a comprehensive list of surgical and no-surgical inpatient care (including complicated maternal care) available in the public hospitals and empanelled private hospitals. The coverage includes pre-existing illnesses, but excludes dental and ophthalmic care. The scheme offers a benefit of 5 Lakh Taka for covering all medical costs (excluding transport charges) of inpatient care for a block period of 5 years and 5 Lakh Taka for death benefit. The estimated premium is 500 Taka per month (400 Taka per month for health insurance and 100 Taka per month for life and accident related disability insurance).The hospitalization benefit is on a floater basis i.e. the total coverage can be availed of individually or collectively by the employees and their eligible family members during the said block period with no restriction on the number of times of availing. Subscription may be deducted from salary or medical allowance. If the spouse is also a government employee then subscription may be deducted from one of them. Some infrastructural constraints need to be addressed while introducing the scheme. These, for example, are capacity constraints of public hospitals; lack of provision of local fund in the public hospitals for regular maintenance of medical equipment and continuous supply of reagents for diagnostic tests to smoothen the services and increasing quality of care; provision of sufficient amount of all necessary drugs in the public hospitals; lack of an effective referral chain in the public hospitals; capacity constraints of the existing insurance companies; and lack of third party administrator (TPA). Establishing a powerful autonomous body is also crucial, due to capacity constraints of the existing insurance companies, to carry the risk of such a big pool of population. The main role of this body is to manage insurance fund, carry the risk and to monitor and supervise the health services to be provided under the scheme. The role of the insurance companies may be limited to claim settlement, issuing of smart card, etc.