Costing of Healthcare Services in Bangladesh: The Journey Begins

The government of Bangladesh has adopted a healthcare financing strategy that aspires to move toward universal health coverage for its population by 2032. The strategy has three objectives to mobilize resources for health: improve equity of healthcare services, improve access to healthcare services, and enhance the efficiency of the health system. The strategy prioritizes protecting not only the poor from the financial burden related to healthcare costs but also providing coverage for the entire population.

The Health Economics Unit of the Bangladesh Ministry of Health and Family Welfare is the implementing agency for the healthcare financing strategy. The unit is a research and policy advisory body that works in different areas to operationalize universal health coverage efforts. The unit conducts research in health economics and finance related topics, including national health accounts and assessment of the quality of care of public health facilities.

The unit is planning to introduce a social health protection program for the poor as a startup program called Shasthyo Shuroksha Karmasuchi (SSK). The startup program will begin in three Upazila (blocks or subdistricts) of Tangail district. The objective of the program is to improve access to high quality healthcare, especially for the poor and vulnerable, by reducing out of pocket payments.

Bangladesh is moving toward designing its health insurance programs, including the provider payments methods. The payment system needs to be based on scientific evidence of how much a health service will cost. A well designed payment system will help ensure the sustainability of the universal health coverage efforts.

Last August, two members from the Health Economics Unit – Mr. Mohammed Nuruzzaman, Director of Research, and Dr. Mohammed Sabbir Haider, Deputy Director – participated in our train the trainer workshop on costing of health services for provider payments. (Click here to read our blog post about the workshop.) The workshop was an initiative of the Costing Collaborative of the Joint Learning Network for Universal Health Coverage. We designed and conducted the costing workshop in partnership with the government of Karnataka. Since returning home to Dhaka, Mr. Nuruzzaman and Dr. Haider have been planning to share the lessons and experience from the workshop. The Health Economics Unit wants to establish a long term capacity building program on costing of health services for provider payments. The unit also plans to create a pool of costing experts who will perform costing studies and design the costing course in Bangladesh. This in country capacity building will help Bangladesh build sufficient costing data and information to inform policymakers and to develop benefit packages for the Shasthyo Shuroksha Karmasuchi program. The Health Economics Unit has identified a core group of twelve members, including experts from Health Economics Unit; the Institute of Health Economics, Dhaka University; the International Centre for Diarrheal Diseases and Research, Bangladesh; and the Bangladesh Rural Advancement Committee (BRAC).

On January 30, 2016, the Health Economics Unit organized a meeting to brainstorm and discuss the overall costing capacity building plan. The objectives of the meeting were to share the experience from the train the trainer costing workshop in India, to plan a sensitization workshop for policymakers, and to discuss how to plan subsequent costing trainings for local experts.

At the January meeting, Mr. Nuruzzaman argued that health financing is one of the most important pillars in the healthcare system in any country. “The government of Bangladesh has already endorsed the healthcare financing strategy (HCFS), with a goal of moving toward universal health coverage,” he said. “To achieve universal health coverage, we have to know about the costing of services with regards to provider payment mechanisms, in addition to other domains of health insurance.” He also pointed out that there is limited capacity, at present. The unit must be proactive in building capacity in costing. He then asked that each participant share his or her views on this work.

The local experts offered ideas, input, and insight about how to build capacity in costing of health services. This group of experts will act as a technical working group to review the costing program regularly and to implement the costing capacity building program in Bangladesh.

My colleague Sireesha Perabathina, who directs our work on the Joint Learning Network, discussed the importance of costing healthcare services in the context of establishing provider payments. She also spoke about the role of the Joint Learning Network and ACCESS Health International in helping to advance this work. She spoke about the Joint Learning Network Collaborative on Costing of Health Services for Provider Payment. This group provides an ongoing forum for technical level professionals, both those conducting costing analyses and those using costing analyses for provider payments, to share experiences and solve common problems. She explained how the Costing Collaborative developed a manual on costing of health services. The manual can be instrumental in building capacity at the country level in costing for health systems.

During the meeting, I had a chance to explain how costing information will help provide evidence for setting realistic payment rates for purchasing health services, especially from private providers. Costing will help health policymakers and payers to negotiate with providers and create the right incentives within the Shaystha Suraksha Kormasuchi program. Some of the participants had doubts about how the costing of health services for provider payments differs from estimating the cost of an essential service package. I explained that costing of health services for provider payment can help inform the cost estimates for a particular healthcare procedure in a hospital setting, whereas costing of an essential service package will help in estimating the budgetary requirements for a particular set of health services at a national or regional level.

Initially, this group of health financing experts and economists will be trained in costing for provider payments in Bangladesh. The group also suggested organizing a sensitization workshop for policymakers on the subject of costing and why it is important for Bangladesh to build the capacity of practitioners in this area. The Health Economics Unit will formalize this technical working group and share its costing plan with this group of experts. The unit will set a list of detailed activities and timeline for the next twelve months. The unit will sign a memorandum of understanding with each of the institutions that participated in the brainstorming meeting.

Mr. Hafizur Rahman, the director of Shaystha Suraksha Kormasuchi, closed the workshop by highlighting the importance of this costing initiative and emphasizing the next steps. The Health Economics Unit will seek support from other international donors and technical partners to take this work forward.