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Justifying increased health budget to improve health care
Shafiun Nahin Shimul | Published: June 13, 2024 21:18:26
Bangladesh has made remarkable progress in its healthcare sector, earning praise both nationally and internationally. However, behind these achievements lies a worrying reality: the sector is full of inefficiencies and weaknesses, heavily exposed by several national and international emergencies, including Covid-19. This has brought to light the urgent need to increase investment in health.
Despite repeated warnings from experts about rising out-of-pocket expenses and the crippling financial burden of high medical costs, timely actions have been few and far between. The urban population, in particular, suffers from a lack of adequate healthcare infrastructure. The government’s response often seemed uncertain and inadequate.
Currently, Bangladesh allocates only a fraction of its GDP to health. Worse still, this allocation has either decreased or remained almost the same. Mismanagement and corruption divert much-needed funds, leaving a pitiful sum for a sector. Consequently, out-of-pocket expenditure dominates health financing, pushing around five million people into poverty every year. The goal of achieving Universal Health Coverage (UHC) remains a distant dream unless immediate action is taken.
Increasing the healthcare budget is not just necessary – it is imperative. The funds are crucial to implementing essential reforms and improvements currently blocked by inadequate funding. For example, reforming the healthcare system to include mandatory universal prepayment mechanisms, such as social health insurance, would ease the financial burden on citizens. But these radical changes require substantial investments. Although the Bangladesh economy does not have the formal employment necessary for this initiative to work, the lack of capacity will continue to be an obstacle for a long time.
The government’s current capacity to manage these reforms is woefully limited. The corporate insurance sector is equally unprepared. Furthermore, healthcare services are overwhelmingly concentrated in large cities, making it difficult to implement effective insurance mechanisms. A larger budget is essential to expand and distribute health services more equitably.
An increase in the health budget would also strengthen governance, improve service capacity and promote innovative financing. The poor quality of public healthcare forces many to seek unregulated private services, worsening financial pressure. Clear clinical guidelines and regulated prices for diagnostics and other healthcare costs are essential. Hospitals need to be categorized by quality, with corresponding prices, and a robust monitoring system must be established. These measures require significant financial resources, justifying a budget increase.
Pharmaceutical prices are another important driver of current expenditure. Companies often produce unnecessary medicines to circumvent regulated prices. Increased funding can support stronger regulatory frameworks to curb this exploitative practice. Although Bangladesh has extensive healthcare infrastructure, the quality of primary care services must improve to make these facilities effective and reduce out-of-pocket payments. This improvement requires greater financial resources.
Furthermore, it is crucial to improve support services in government facilities. Employer-based insurance for formal enterprises and large companies could improve risk sharing, although it may increase disparities between rural and urban areas. Policymakers should also consider those just above the poverty line and make strategic purchases to reduce costs. These initiatives also require a higher health budget.
Preventive care, which is cost-effective and reduces future curative expenses, should be prioritized. Increasing investment in preventative care is essential to reducing overall health care costs and improving health outcomes. Furthermore, the inclusion of much-needed services such as mental health services and geriatric services – which are significantly missing in the current system – would require more resources. Discouraging unhealthy habits, such as tobacco consumption, requires combinations of policies – both fiscal and non-fiscal.
The complexity of the healthcare system means there is no simple solution. Policies must be context-specific and evidence-based, with good governance to optimize resource allocation. While a robust health system in the long term is crucial, immediate measures can significantly reduce out-of-pocket expenses and improve the quality of health care. Increasing the healthcare budget is a critical step toward making these necessary changes.
The time for complacency is over. The time has come for Bangladesh to invest in the health of its people. Adding new services and improving the quality of care requires resources. So increasing the healthcare budget is not just a financial imperative – it is a moral imperative.
Shafiun Nahin Shimul PhD, Professor Institute of Health Economics, University of Dhaka. shafiun.ihe@du.ac.bd