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

Sarker, Abdur Razzaque and Sultana, Marufa and Alam, Khorshed ORCID: 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 0749-6753


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.

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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Files associated with this item cannot be displayed due to copyright restrictions.
Faculty/School / Institute/Centre: Current - Faculty of Business, Education, Law and Arts - School of Business (18 Jan 2021 -)
Faculty/School / Institute/Centre: Current - Institute for Resilient Regions - Centre for Health Research (1 Apr 2020 -)
Date Deposited: 17 Sep 2021 06:20
Last Modified: 23 Jun 2022 04:30
Uncontrolled Keywords: Bangladesh; healthcare expenditure; health financing incidence analysis; out-of-pocket cost
Fields of Research (2008): 11 Medical and Health Sciences > 1117 Public Health and Health Services > 111712 Health Promotion
14 Economics > 1402 Applied Economics > 140208 Health Economics
11 Medical and Health Sciences > 1117 Public Health and Health Services > 111717 Primary Health Care
Fields of Research (2020): 42 HEALTH SCIENCES > 4203 Health services and systems > 420399 Health services and systems not elsewhere classified
38 ECONOMICS > 3801 Applied economics > 380108 Health economics
42 HEALTH SCIENCES > 4206 Public health > 420606 Social determinants of health
Socio-Economic Objectives (2008): C Society > 92 Health > 9204 Public Health (excl. Specific Population Health) > 920499 Public Health (excl. Specific Population Health) not elsewhere classified
B Economic Development > 91 Economic Framework > 9102 Microeconomics > 910209 Preference, Behaviour and Welfare
C Society > 92 Health > 9202 Health and Support Services > 920206 Health Inequalities
Socio-Economic Objectives (2020): 20 HEALTH > 2004 Public health (excl. specific population health) > 200499 Public health (excl. specific population health) not elsewhere classified
15 ECONOMIC FRAMEWORK > 1505 Microeconomics > 150509 Preference, behaviour and welfare
20 HEALTH > 2002 Evaluation of health and support services > 200204 Health inequalities
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