Syed Abdul Hamid

Can Micro Health Insurance Reduce Poverty? Evidence from Bangladesh

This paper examines the impact of micro health insurance on poverty reduction in rural areas of Bangladesh. The research is based on household level primary data collected from the operating areas of the Grameen Bank during 2006. A number of outcome measures relating to poverty status are considered; these include household income, stability of household income via food sufficiency and ownership of non-land assets, and also the probability of being above or below the poverty line. The results show that micro health insurance has a positive association with all of these indicators, and this is statistically significant and quantitatively important for food sufficiency.

Responsiveness of the urban primary health care delivery system in Bangladesh: A comparative analysis

This study analyses the responsiveness of outpatient care to assess the quality of urban primary health care among all 5 types of health care providers in Bangladesh, namely, the Urban Primary Health Care Services Delivery Project, the NGO Health Services Delivery Project (NHSDP), NGOs, private hospitals, and the Ministry of Health and Family Welfare (MOHFW). Other than some public-private comparisons, there is an absolute knowledge gap regarding responsiveness in urban health systems, particularly in the context of Bangladesh, and this gap motivates this study. The study used primary data collected from 810 randomly selected outpatients. The survey used a structured questionnaire on all 7 domains of responsiveness of outpatient care suggested by the World Health Organization. The estimated mean responsiveness score reveals that overall, approximately 33% of the patients rated the responsiveness of the system as poor. In reported responsiveness, the NHSDP was ranked at the top and the MOHFW at the bottom. The latter is quite expected. Overall, prompt attention and autonomy were the worst-performing domains, and choice of provider, dignity, and clear communication were the better-performing ones. The results suggest the need to improve the degree of responsiveness of all domains, especially those that are more concerned with access to health care, namely, prompt attention, dignity, clear communication, and confidentiality. The Ministry of Health and Family Welfare facilities should give additional consideration to promote prompt attention, autonomy, and quality of basic amenities. Private facilities should also provide additional stress on improving prompt attention and autonomy. The nontherapeutic quality of health care needs to be emphasized in the medical education system. Further research based on household surveys could be worthwhile to measure responsiveness more comprehensively.

Micro Health Insurance in Bangladesh: Innovations in Design, Delivery and Distribution Channels

Bangladesh needs to start afresh with innovative means of financing the provision of health care since in its absence the poor end up relying largely on self-insurance devices to mitigate health risks, which entails high implicit premiums. Existing insurance type programmes essentially consist of subsidy-oriented interventions, not necessarily in kind, requiring upfront cash at each stage of service delivery, hence failing to overcome the incidence of high out-of-pocket (OOP) payments, nor do the existing programmes succeed in dealing with events leading to catastrophic payments. Given this vacuum, an innovative micro health insurance (MHI) scheme has been designed keeping in view the targets of adequate risk protection, inclusivity of access, affordability and programme sustainability. The research design embracing the methods of cluster randomised trial allows for identification of direct and indirect effects of MHI on actual OOP incurred by the insured vis-a-vis the non-insured households who are otherwise similar in economic, educational and social dimensions. Such an analysis holds the promise of determining whether MHI type of intervention may eventually lead to large-scale implementation so that quality health care reach the poor en masse thereby contributing to the cause of universal health coverage. Key Words: Micro Health Insurance, Cluster Randomised Trials, Out-of-Pocket Payments, Cost of Risks JEL Classification Code: C83, G21, G22 and I18