In Bangladesh, organized universal health coverage has not yet been introduced. Private health care is affordable to only the high-income group. The Bangladeshi garment industry with its large low-income labor force is important to the nation’s economy and employment, especially for women. A tested institutional model for employer-sponsored health insurance (ESHI) scheme was developed to increase health care with improved disease prevention and health promotion, access to health information, and efficient cost control through a health financing plan.
A total of 9717 garment workers aged between 18 to 60 years and belonging to the lowest salary groups of seven readymade garment (RMG) factories of Gazipur district were included in a health microinsurance (HMI) program from 24 April 2014 to 23 April 2015. The HMI program was developed jointly by the insurer United Insurance Company Limited (UIC), the health service provider Diabetic Association of Bangladesh (BADAS), the Telemedicine Reference Centre Pvt. Ltd. (TRCL), and garment factories under the New Asia Group. The model used in the HMI project included treatment (treatment at site, telemedicine, and hospitalization at BADAS hospitals), laboratory facilities, health education (included health promotion and disease prevention), and supply of medicine. The scheme provided coverage for treatment with a cost of up to 15000 Bangladeshi taka (BDT) or US$192.8 annually. The premium for enrolment in the scheme was 487 BDT (US$6.3) per year, which was borne by the employer. A software application was used to provide end-to-end reports from workers to the medical service provider (BADAS) and further to the insurance company. The medical service provider and insurance used the same software application to generate and view medical records, prescriptions, and hospital claims. A total 4524 (2735 male and 1789 female) RMG workers, had received treatment. The mean age of the participant was 28.3 years. A total of 15354 medical consultancies were recorded during the project. The median value of drug cost, investigation cost, consultancy fees, and total medical cost were 126 (1.49 USD), 315 (3.71 USD), 200 (2.36 USD), and 734 BDT (8.66), respectively. The annual net premium paid by the factory owner was 40 94,504 BDT (48,744 USD), and the total healthcare cost accrued was 52,30,156 BDT (62,263 USD).
The HMI model intended to analyze and develop a market niche for group health insurance for Bangladesh’s garment industry workers and share data, experiences, obstacles, and lessons to learn with a broader health sector development community. Especial focuses were learning, replication, scaling, and policy development process. Various types of materials and infrastructure were developed within the project time period i.e., treatment guidelines and code of diagnoses, Call Center, HMI software, health educational booklets and videos being important capital resources which may be used further during program extension.
Corresponding author
National Professor AK Azad Khan
President, Diabetic Association of Bangladesh (BADAS) & Chair, Centre for Global Health Research, BADAS
