J Prev Med Public Health.  2017 Mar;50(2):91-99. 10.3961/jpmph.16.089.

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh

• Mahumud RA
• Sarker AR
• Sultana M
• Islam Z
• Khan J
• Morton A

• KMID: 2378096
• DOI: http://doi.org/10.3961/jpmph.16.089

Abstract

OBJECTIVES
As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh.
METHODS
A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method.
RESULTS
The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures.
CONCLUSIONS
The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

Keyword

Out-of-pocket; Risk pooling mechanism; Social financial safety; Gross domestic product per capita; Bangladesh

MeSH Terms

Bangladesh*
Delivery of Health Care*
Family Characteristics
Health Expenditures*
Healthcare Financing
Humans
Insurance, Health
Marital Status
Methods
Unemployment