Health Reform Commission focuses on reducing out-of-pocket healthcare costs

Infographic: TBS

The Health Sector Reform Commission is exploring ways to reduce the financial burden of healthcare on Bangladeshis, proposing measures such as introducing a referral system, lowering medicine prices, ensuring accurate diagnostic tests, and providing free treatment for underprivileged patients.

The 12-member commission aims to make healthcare more accessible, affordable, and universal when a WHO estimation of 2022 shows Bangladeshis bear 72.5% of their total healthcare expenses out of their own pockets. 

The burden has pushed 61 lakh people into poverty that year, according to the Bangladesh Institute of Development Studies (BIDS).

The commission, formed by the interim government in October last year, is engaging with various stakeholders and plans to submit its report by mid-February.

Professor AK Azad Khan, the commission's chief, said the report would include proposals to establish free treatment for poor patients, regulate medicine prices, and ensure logical diagnostic tests.

"The commission aims to present short, medium, and long-term policy-related recommendations to the government, ensuring necessary reforms to make healthcare accessible and universal," he told TBS.

Prioritising referral systems and preventative care

Commission member Dr Muzaherul Huq, a former regional adviser at the World Health Organisation, highlighted the need to prioritise disease prevention and early-stage treatment.

"A robust public health system is essential to reducing treatment costs. Preventing diseases and treating them early can significantly cut healthcare expenses," he told TBS.

Muzaherul also stressed the importance of a referral system that ensures patients, regardless of their financial status, can access treatment from upazila-level facilities to national hospitals.

"This system would ensure equitable treatment access and help reduce overall costs," he added.

A referral system requires patients to see a general practitioner first, who will then refer them to a specialist if necessary. A referral system could filter 65% of patients at lower-level facilities, easing pressure on tertiary hospitals, a study found.

The commission is also considering ways to ensure accountability in the healthcare sector.

Muzaherul said, "Doctors must practise ethically, and pharmaceutical companies should operate ethically to reduce costs related to tests and medicines. Monitoring and supervision need to be strong, with recommendations for accountability, rewards, and punishments at every level."

Free services and drug price regulation

Commission member Prof Dr Muhammad Zakir Hossain proposed providing free outdoor and indoor services in government hospitals for 20% of the population living below the poverty line.

Additionally, private hospitals could be required to offer 9% of their indoor services and 1% of medicines and diagnostic tests free of charge for poor patients.

"To ensure effective implementation, there will be a system of monitoring and review assessments at every level, from upazilas to national institutions," Zakir told TBS.

A commission member, speaking anonymously, pointed out that medicines are the largest component of out-of-pocket expenses.

The member suggested regulating the prices of essential medicines and subsidising emergency and chronic treatments, such as dialysis, to reduce financial burdens.

"In our country, healthcare expenditure accounts for only 2.5% of the total economy, with government expenditure less than 1%. This allocation must be increased to make meaningful improvements," the member said.

Improving private sector services

At a recent meeting at Khulna Medical College, commission member MM Reza noted that private hospitals and clinics have more beds and, in some cases, better laboratory facilities than government institutions. He stressed the need to enhance service delivery in both public and private sectors.

"To ensure universal health coverage, we must increase service capacity and bring people under financial health coverage. Without this, a significant portion of the population will remain deprived of basic healthcare services," Reza explained.

The commission's upcoming report is expected to address these issues comprehensively, with a focus on reducing financial barriers to healthcare and ensuring equitable access for all.

What independent experts say

Healthcare experts also agreed with the need for these reforms and suggested several measures to improve the sector.

Dr MH Choudhury Lelin, public health expert and chairman of Health and Hope Hospital, told TBS that millions of people each year fall below the poverty line due to healthcare expenses, out of which a significant portion of these out-of-pocket expenditures is spent on medicines.

"If the government introduces a rationing system for essential medicines targeting impoverished patients, those suffering from chronic conditions such as thyroid disorders and diabetes, which require lifelong medication, could access these medicines at prices closer to their production costs," he said.  

To implement this, he suggested a card-based system that will allow patients to purchase medicines at reduced prices from Essential Drugs Company outlets by showing the card.

Besides, a medical safety network must be created for the 20% of the population living below the poverty line. This network would ensure access to free or subsidised treatment, medicines, and diagnostic tests, he added.

"Along with the issues that the reform commission discussed to reduce out-of-pocket expenditure, investments must also be made in ensuring primary healthcare, increasing investment in nutrition, and creating health literacy," Dr Abu Jamil Foisal, a public health expert, told The Business Standard.

"If nutrition is managed properly, diseases will decrease. If people develop health literacy, they will buy fewer unnecessary medicines, which will reduce costs. To bring about behavioural change in people, health literature must be taught from the school level.

"Currently, investment in nutrition and primary healthcare is very low. Out-of-pocket expenses will not decrease if this is not increased. Without doing that, simply taking medicine when sick or building hospitals will not reduce out-of-pocket expenses. The work to prevent disease must be done."