Utilisation of Formal Health Care and Out-of-Pocket Payments in Rural Bangladesh

This paper provides an analysis of the utilisation of formal health care and out-ofpocket (OOP) payments in rural areas of Bangladesh. The broader focus of the investigation is to gauge how far Bangladesh has to traverse to achieve universal health coverage (UHC). We used the data from the baseline survey (conducted in diversifi ed geographical locations on about 4,000 households) of a longitudinal research project (entitled Microinsurance, Poverty and Vulnerability) of the Institute of Microfi nance (InM). The study fi nds that over 12-month period, only 40 per cent of the 6,352 sick individuals utilised formal health care. The poor and the children are the most deprived section in the utilisation. Out-of-pocket expenses per affected household during 12 months preceding the survey was BDT 4,686, which accounted for about 6 per cent of the total household expenditure. Drug, the single largest component of the OOP category, accounts for about 60 per cent of the direct OOP expenditure. The incidence of catastrophic expenditure was 15 per cent at the 10-per cent threshold level. In about 33 and 41 per cent of the cases, households needed to borrow or deplete assets for coping with inpatient care and catastrophic illnesses, respectively. Poor effective access to formal healthcare and high OOP expenditure indicate that Bangladesh has major challenges to overcome in achieving the universal health coverage. Membership in Grameen Kalyan micro health insurance scheme, essentially a discounted basic care package, has a significant association with the likelihood of using formal health care, though access to microcredit appear not to relieve households of the need to search for additional funds to cope with catastrophic events. An obvious suggestion is to introduce a risk-sharing mechanism (e.g., micro health insurance) to pool funds for the provision of health care in rural areas. Awareness building on the value of professional medical advice and measures targeted at effective regulation of the prices of essential drugs and restricting the sales of over-the-counter drugs are also put forward as elements of a sound public health policy framework.