The Health Sector Reform Commission has recommended creating a national "Essential Diagnostics List (EDL)" and setting fixed prices for diagnostic tests to improve quality and ensure cost-effectiveness in diagnostic services.

The commission also suggested introducing a performance-based grading system for private hospitals and clinics to help patients make informed decisions, improve service quality, and ensure greater transparency and accountability.

Led by Prof AK Azad Khan, the commission submitted its report on Monday.

It also called for mandatory Social Health Insurance (SHI) to protect patients from the financial burden of treatment.

These recommendations come amid growing concern over the lack of standard pricing for lab tests. Currently, diagnostic centres charge varying rates for the same tests, leaving patients vulnerable.

Out-of-pocket (OOP) healthcare spending in Bangladesh remains high -- over 70 percent -- which often forces patients with diseases like cancer, kidney failure, and heart conditions to discontinue treatment or fall deeper into poverty.

In its report, the commission stressed that a national Essential Diagnostics List must be introduced based on World Health Organization (WHO) guidelines and the country's disease burden. This list must be enforced as a standard for all public and private laboratories, it said.

There are 19,627 registered private hospitals and clinics and 35,597 private diagnostic centres in the country as of April this year, according to the Directorate General of Health Services.

A cost-based pricing system must be implemented for the listed tests, allowing for reasonable variations based on the type of service and region, said the report.

However, strict measures must be taken to prevent excessive pricing, especially in urban areas, it added.

The report said global examples show that such initiatives effectively reduce inequalities and prevent unnecessary expenses.

It noted that over 20 countries have already adopted the WHO's EDL, resulting in better access to diagnostic services and reduced patient costs.

"Bangladesh must also introduce this system without delay," said the commission, adding that it would expand access to essential tests, reduce financial burden, and minimise waste in diagnostic services.

It also recommended a performance-based grading system (A–D) for private hospitals and clinics, along with an institutional accreditation process for service recognition. This system should include monitoring of ICU service quality, hospital infection rates, and antibiotic stewardship.

To ensure service quality and accountability, hospitals with more than 50 beds must form a management board led by a senior physician, it said.

The commission further recommended introducing mandatory Social Health Insurance in the country.

This insurance would provide financial protection against catastrophic healthcare costs arising from cancer, kidney failure, complex surgeries, and other chronic illnesses.

Initially, the insurance should be compulsory for public and private sector employees, funded by joint employer-employee contributions. The government should subsidise premiums to include poor and vulnerable populations under the scheme, said the report.

In later stages, workers from the informal sector should be brought in through targeted subsidies and partial payments.

The report said countries like Germany, Japan, South Korea, and Vietnam have successfully implemented the initiative by combining mandatory premiums, subsidies, and multi-payer funding models.

"Introducing SHI in Bangladesh will improve access to expensive healthcare, reduce poverty caused by medical expenses, and create a stable and coordinated financing system for the health sector," the commission said.