IDEAS home Printed from https://ideas.repec.org/a/bla/ijhplm/v36y2021i6p2106-2117.html
   My bibliography  Save this article

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

Author

Listed:
  • Abdur Razzaque Sarker
  • Marufa Sultana
  • Khorshed Alam
  • Nausad Ali
  • Nurnabi Sheikh
  • Raisul Akram
  • Alec Morton

Abstract

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.

Suggested Citation

  • Abdur Razzaque Sarker & Marufa Sultana & Khorshed Alam & Nausad Ali & Nurnabi Sheikh & Raisul Akram & Alec Morton, 2021. "Households' out‐of‐pocket expenditure for healthcare in Bangladesh: A health financing incidence analysis," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(6), pages 2106-2117, November.
    • Handle: RePEc:bla:ijhplm:v:36:y:2021:i:6:p:2106-2117
    DOI: 10.1002/hpm.3275
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hpm.3275
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hpm.3275?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Selden, Thomas M., 1993. "Uncertainty and health care spending by the poor: The health capital model revisited," Journal of Health Economics, Elsevier, vol. 12(1), pages 109-115, April.
    2. Augustine Asante & Jennifer Price & Andrew Hayen & Stephen Jan & Virginia Wiseman, 2016. "Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-20, April.
    3. Ahmed, Syed Masud & Adams, Alayne M. & Chowdhury, Mushtaque & Bhuiya, Abbas, 2000. "Gender, socioeconomic development and health-seeking behaviour in Bangladesh," Social Science & Medicine, Elsevier, vol. 51(3), pages 361-371, August.
    4. Mohammad Abu-Zaineh & Habiba Romdhane & Bruno Ventelou & Jean-Paul Moatti & Arfa Chokri, 2013. "Appraising financial protection in health: the case of Tunisia," International Journal of Health Economics and Management, Springer, vol. 13(1), pages 73-93, March.
    5. Gabriela Flores & Jaya Krishnakumar & Owen O'Donnell & Eddy van Doorslaer, 2008. "Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1393-1412.
    6. Koen Peeters Grietens & Alphonse Um Boock & Hans Peeters & Susanna Hausmann-Muela & Elizabeth Toomer & Joan Muela Ribera, 2008. "“It Is Me Who Endures but My Family That Suffers”: Social Isolation as a Consequence of the Household Cost Burden of Buruli Ulcer Free of Charge Hospital Treatment," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 2(10), pages 1-7, October.
    7. Syed Hamid & Syed Ahsan & Afroza Begum, 2014. "Disease-Specific Impoverishment Impact of Out-of-Pocket Payments for Health Care: Evidence from Rural Bangladesh," Applied Health Economics and Health Policy, Springer, vol. 12(4), pages 421-433, August.
    8. Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan‐Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184, November.
    9. Kakwani, Nanok C, 1977. "Measurement of Tax Progressivity: An International Comparison," Economic Journal, Royal Economic Society, vol. 87(345), pages 71-80, March.
    10. Gabriela Flores & Jaya Krishnakumar & Owen O'Donnell & Eddy van Doorslaer, 2008. "Coping with health‐care costs: implications for the measurement of catastrophic expenditures and poverty," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1393-1412, December.
    11. James Alm & Keith Finlay, 2013. "Who Benefits from Tax Evasion?," Economic Analysis and Policy, Elsevier, vol. 43(2), pages 139-154, September.
    12. Somkotra, Tewarit & Lagrada, Leizel P., 2008. "Payments for health care and its effect on catastrophe and impoverishment: Experience from the transition to Universal Coverage in Thailand," Social Science & Medicine, Elsevier, vol. 67(12), pages 2027-2035, December.
    13. Owen O'Donnell & Eddy van Doorslaer & Ravi P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Deni Harbianto & Charu C. Garg & Piya Hanvoravongchai & Mohammed N. Huq & Anup Karan & Gabriel M., 2007. "The Incidence of Public Spending on Healthcare: Comparative Evidence from Asia," The World Bank Economic Review, World Bank, vol. 21(1), pages 93-123.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Mohamed Fakhri Abu Baharin & Muhamad Hanafiah Juni & Rosliza Abdul Manaf, 2022. "Equity in Out-of-Pocket Payments for Healthcare Services: Evidence from Malaysia," IJERPH, MDPI, vol. 19(8), pages 1-15, April.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Abdur Razzaque Sarker & S M Zulfiqar Ali & Maruf Ahmed & S M Zahedul Islam Chowdhury & Nausad Ali, 2022. "Out-of-pocket payment for healthcare among urban citizens in Dhaka, Bangladesh," PLOS ONE, Public Library of Science, vol. 17(1), pages 1-20, January.
    2. HyunWoo Jung & Kwang-Soo Lee, 2022. "What Policy Approaches Were Effective in Reducing Catastrophic Health Expenditure? A Systematic Review of Studies from Multiple Countries," Applied Health Economics and Health Policy, Springer, vol. 20(4), pages 525-541, July.
    3. Afroza Begum & Syed Abdul Hamid, 2021. "Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?," PLOS ONE, Public Library of Science, vol. 16(6), pages 1-21, June.
    4. Navneet Manchanda & Dil Bahadur Rahut, 2021. "Inpatient Healthcare Financing Strategies: Evidence from India," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 33(6), pages 1729-1767, December.
    5. Barnes, Kayleigh & Mukherji, Arnab & Mullen, Patrick & Sood, Neeraj, 2017. "Financial risk protection from social health insurance," Journal of Health Economics, Elsevier, vol. 55(C), pages 14-29.
    6. Meriem Oudmane & Fouzi Mourji & Abdeljaouad Ezzrari, 2019. "The impact of out‐of‐pocket health expenditure on household impoverishment: Evidence from Morocco," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1569-1585, October.
    7. Eddy van Doorslaer & Owen O'Donnell, 2008. "Measurement and Explanation of Inequality in Health and Health Care in Low-Income Settings," WIDER Working Paper Series DP2008-04, World Institute for Development Economic Research (UNU-WIDER).
    8. Aleksandra Kolasa & Ewa Weychert, 2024. "The causal effect of catastrophic health expenditure on poverty in Poland," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(2), pages 193-206, March.
    9. Syed M. Ahsan & Syed Abdul Hamid & Shubhasish Barua, 2012. "Utilisation of Formal Health Care and Out-of-Pocket Payments in Rural Bangladesh," Working Papers 13, Institute of Microfinance (InM).
    10. Tomson Ogwang & Germano Mwabu, 2024. "Adaptation of the Foster‐Greer‐Thorbecke poverty measures for the measurement of catastrophic health expenditures," Health Economics, John Wiley & Sons, Ltd., vol. 33(10), pages 2419-2436, October.
    11. Kim, Chang-O & Joung, Won Oh, 2014. "Effect of the Crisis Assistance Program on poverty transition for seriously ill people in South Korea: A quasi-experimental study," Social Science & Medicine, Elsevier, vol. 101(C), pages 28-35.
    12. Jay Dev Dubey, 2021. "Measuring Income Elasticity of Healthcare-Seeking Behavior in India: A Conditional Quantile Regression Approach," Journal of Quantitative Economics, Springer;The Indian Econometric Society (TIES), vol. 19(4), pages 767-793, December.
    13. Sean Higgins & Nora Lustig & Whitney Ruble & Timothy M. Smeeding, 2016. "Comparing the Incidence of Taxes and Social Spending in Brazil and the United States," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 62(S1), pages 22-46, August.
    14. Binyaruka, Peter & Martinez-Alvarez, Melisa & Pitt, Catherine & Borghi, Josephine, 2024. "Assessing equity and efficiency of health financing towards universal health coverage between regions in Tanzania," Social Science & Medicine, Elsevier, vol. 340(C).
    15. Mingsheng Chen & Yuxin Zhao & Lei Si, 2014. "Who Pays for Health Care in China? The Case of Heilongjiang Province," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-11, October.
    16. Eunkyoung Kim & Soonman Kwon, 2021. "The effect of catastrophic health expenditure on exit from poverty among the poor in South Korea," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(2), pages 482-497, March.
    17. Flores, Gabriela & O’Donnell, Owen, 2016. "Catastrophic medical expenditure risk," Journal of Health Economics, Elsevier, vol. 46(C), pages 1-15.
    18. Syeda Anam Fatima Rizvi, 2021. "Household Catastrophic Health Expenditures and its Determinants in Pakistan," Post-Print hal-03341700, HAL.
    19. Xiaoyu Wang & Chunan Wang, 2020. "How Does Health Status Affect Marginal Utility of Consumption? Evidence from China," IJERPH, MDPI, vol. 17(7), pages 1-20, March.
    20. Sparrow, Robert & Suryahadi, Asep & Widyanti, Wenefrida, 2013. "Social health insurance for the poor: Targeting and impact of Indonesia's Askeskin programme," Social Science & Medicine, Elsevier, vol. 96(C), pages 264-271.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bla:ijhplm:v:36:y:2021:i:6:p:2106-2117. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www.blackwellpublishing.com/journal.asp?ref=0749-6753 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.