Cost of illness for outpatients attending public and private hospitals in Bangladesh

Pavel, Md Sadik and Chakrabarty, Sayan and Gow, Jeff (2016) Cost of illness for outpatients attending public and private hospitals in Bangladesh. International Journal for Equity in Health, 15 (167). pp. 1-12. ISSN 1475-9276

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Background: A central aim of Universal Health Coverage (UHC) is protection for all against the cost of illness. In a low income country like Bangladesh the cost burden of health care in tertiary facilities is likely to be significant for most citizens. This cost of an episode of illness is a relatively unexplored policy issue in Bangladesh. The objective of this study was to estimate an outpatient’s total cost of illness as result of treatment in private and public hospitals in Sylhet, Bangladesh.

Methods: The study used face to face interviews at three hospitals (one public and two private) to elicit cost data
from presenting outpatients. Other socio-economic and demographic data was also collected. A sample of 252
outpatients were randomly selected and interviewed. The total cost of outpatients comprises direct medical costs,
non-medical costs and the indirect costs of patients and caregivers. Indirect costs comprise travel and waiting times
and income losses associated with treatment.

Results: The costs of illness are significant for many of Bangladesh citizens. The direct costs are relatively minor
compared to the large indirect cost burden that illness places on households. These indirect costs are mainly the
result of time off work and foregone wages. Private hospital patients have higher average direct costs than public hospital patients. However, average indirect costs are higher for public hospital patients than private hospital patients by a factor of almost two. Total costs of outpatients are higher in public hospitals compared to private hospitals regardless of patient’s income, gender, age or illness.

Conclusion: Overall, public hospital patients, who tend to be the poorest, bear a larger economic burden of illness
and treatment than relatively wealthier private hospital patients. The large economic impacts of illness need a public policy response which at a minimum should include a national health insurance scheme as a matter of urgency.

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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Faculty/School / Institute/Centre: Current - Faculty of Business, Education, Law and Arts - School of Commerce
Date Deposited: 17 Oct 2016 04:46
Last Modified: 16 Dec 2016 05:40
Uncontrolled Keywords: total cost of outpatients, direct cost, indirect cost, health care, public vs private, Bangladesh
Fields of Research : 14 Economics > 1402 Applied Economics > 140208 Health Economics
Socio-Economic Objective: C Society > 92 Health > 9202 Health and Support Services > 920206 Health Inequalities
Identification Number or DOI: 10.1186/s12939-016-0458-x

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