This is a guest post by Sylvana Q. Sinha, the founder and chief executive officer of Praava Health, which is raising the bar for healthcare in Bangladesh through international-standard doctors, diagnostics and technology, and a value-based care model that puts patients first.
Last month, Standard Chartered Bank announced that Bangladesh is among seven Asian countries whose Gross Domestic Product (GDP) will grow around 7 percent through 2020. In real terms, this means Bangladesh’s GDP per capita is projected to surpass India’s by 2030.
As one of the fastest-growing economies in the world, Bangladesh has been dubbed the next Asian tiger by the World Economic Forum, The Economist, and others – a far cry from the “basket case” that Henry Kissinger described it at its birth in 1971. This rapid economic growth has contributed to a substantial decrease in poverty from 40 percent in 2005 to less than 30 percent today. A dynamic, growing middle class of nearly forty million people has already propelled Bangladesh to “middle-income” status, according to the World Bank.
While this is great news for Bangladesh, the country is at risk of missing the mark with a healthcare system that is overstretched -- putting all this progress at risk.
Bangladesh, along with several other lower to middle income countries, is currently experiencing what is called a “missing middle” problem. As Bangladesh’s economy grows, development assistance decreases. Meanwhile, government investment in the health sector does not keep pace. In fact, government spending on healthcare as a percentage of GDP in Bangladesh has been decreasing over the last ten years and has barely kept up with inflation. Bangladesh is among the twenty-five worst performing countries when it comes to public health spending.
For Bangladeshi families, this translates to high out-of-pocket costs and poor care. Out of pocket spending accounts for 72 percent of total healthcare spending -- significantly higher than the global average. While incomes are rising among a growing middle class, health costs are increasing at a rate even faster than income, leaving people struggling to afford care. And for all this expense, the average Bangladeshi patient only sees her doctor for forty-eight seconds.
With the public health system understaffed and overstretched, private health facilities are left to fill the gap. Unfortunately, the private system is expensive and highly fragmented – particularly in growing urban areas like Dhaka. The government currently lacks capacity to regulate and monitor private facilities, leaving serious questions about quality. The private sector also focuses on episodic care that is highly transactional, and is driven by backwards incentives that push doctors to hospitalize patients and over-order tests and drugs -- treating patients like dollar signs.
In a country with staggering health costs and poor health infrastructure, thousands of Bangladeshis travel abroad daily seeking better care -- taking their increasing incomes with them and spending it elsewhere.
Rapid economic growth will not continue forever -- especially with an unhealthy foundation. At the same time, rapid economic growth offers Bangladesh the opportunity to build a solid health infrastructure. Now is the time to pivot toward a value-based care model that is holistic, affordable and measurable, for the future health of the country and the economy.
First, the health system should shift emphasis away from expensive hospital stays to patient-centered primary care with family doctors. Care should go beyond simply diagnosing and treating patients, and holistically consider their familial and social circumstances, personal preferences and values. This type of care improves patients’ clinical outcomes and satisfaction by enhancing the quality of the doctor-patient relationship, while at the same time decreasing overall health care costs and wastefulness of diagnostic testing, prescriptions, hospitalizations and referrals. Early data from Praava Health shows that care coordinated by a family doctor, who spends at least fifteen minutes with each patient, improves health outcomes and keeps costs low.
This is particularly important as the disease burden shifts to chronic illness and more patients require continuous health monitoring. Many countries have ignored the economic consequences of rising chronic disease, at no small cost. In countries like the United States, chronic illnesses drive 90 percent of the country’s health spending. Bangladesh cannot afford to go down this same path.
Second, with only 1 percent of the population covered by private insurance, Bangladesh needs to experiment with alternative payment models that focus on quality and outcomes, rather than volume. For example, Praava’s annual membership plans – the first of its kind in Bangladesh – offer unlimited access to our family health professionals on an annual basis. Value-based payment schemes like this should be designed to cover whatever healthcare needs a patient may have, from basic primary care to maternal and early childhood care, to managing chronic illnesses.
Rather than incentivizing doctors based on volume, private facilities should incentivize keeping patients healthy, linking patient outcomes with doctors’ incentives. This would reduce out-of-pocket costs for patients and reduce financial strain on the system.
Lastly, the opportunity to establish strong health informatics is enormous in a country like Bangladesh, where we often lack systematic healthcare data. Praava has already brought Bangladesh its first fully integrated hospital information system, where we can track patient outcomes and maintain accurate medical records. We’re also placing health literally in the palm of patents’ hands through an unprecedented patient portal. To continue on a value-based path, Bangladesh needs to build digital platforms that measure and analyze health data in terms of patient outcomes – both clinical and social – as well as costs across the full pathway of care.
Bangladesh’s continued growth as a nation depends on a healthy, resilient population. With growing demand from Bangladesh’s middle class for better quality healthcare, smart investments in the health sector are urgently needed.
Otherwise, the economy may grow, but Bangladesh’s growing middle class will be left in the dust with crippling healthcare bills that put a ceiling on the country's economic potential.