Households' out-of-pocket expenditure for healthcare in Bangladesh : a health financing incidence analysis

Sarker, Abdur Razzaque and Sultana, Marufa and Alam, Khorshed and Ali, Nausad and Sheikh, Nurnabi and Akram, Raisul and Morton, Alec (2021) Households' out-of-pocket expenditure for healthcare in Bangladesh : a health financing incidence analysis. International Journal of Health Planning and Management, 36 (6). pp. 2106-2117. ISSN 1099-1751 (

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Background: Despite improvements in many health indicators, providing access to affordable healthcare remains a considerable challenge in Bangladesh. Financing incidence analysis will enable an evaluation of how well the healthcare system performs to achieve equity in health financing. The objective of this study is to assess the burden of out-of-pocket (OOP) cost on different socio-economic groups by assessing the health financing incidence because OOP cost dominates household expenditure on health in Bangladesh. Methods: The study was conducted using latest Household Income and Expenditure Survey (HIES) 2016. We focused mainly on four specific indicators: level of monthly household OOP cost on in-patient care, urban-rural differences in OOP cost, socio-economic status differences in different payment mechanisms and the Kakwani index. Descriptive statistics were employed to analyse and summarise the selected variables based on the SES and location of residence (e.g., rural and urban). Results: The study showed the overall OOP healthcare expenditure was 7.7% of the household monthly income while the poorer income group suffered more and spent up to 35% of their household income on healthcare. The Kakwani index indicated that the poorest quintile spends a greater share of their income on healthcare services than the richest quintile. Conclusions: This study observed that OOP cost in Bangladesh is regressive, that is, poorer members of society contribute a greater share of their income. Therefore, policymakers should initiate health reforms for developing and implementing risk-pooling financing mechanisms such as social health insurance to achieve the Universal Health Coverage in Bangladesh.