Syed M. Ahsan
Syed Abdul Hamid
Shubhasish Barua
Mohammad Rifat Haider
Chowdhury Abdullah Al Asif

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-à-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.