Abstract for: A System Dynamics Model of Community-Based Health Insurance System in Bangladesh

Community-based health insurance (CBHI) has been defined as an interim measure to pave the way for the establishment of a comprehensive national health insurance system in Bangladesh. The goal of this study is to identify appropriate policies that support a sustainable CBHI and to assess the impact of these policies over time. A system dynamics approach is used to build a model, simulate, and evaluate policy scenarios. The model was parameterized using data from the literature, primary data collected from a CBHI scheme in Bangladesh, and expert opinion. A series of formal tests were conducted to build confidence in the model. The scenario analysis demonstrates that the best-performing scenarios achieve 33% to 88% population coverage and recover 50% to 55% of the total cost through premium revenue. Medical service costs were determined to be the single largest contributor to the total costs. Therefore, we investigated the sustainability of CBHI by highlighting the significance of risk sharing among insured members. If 20% to 32% of insured members use healthcare benefits once during the duration of their coverage, and approximately 2% use healthcare benefits multiple times, the scheme will become sustainable approximately four years after its implementation from the baseline period.