Inequity in Formal Health Care Use: Evidence from Rural Bangladesh

This paper analyzes inequity in health care use in rural Bangladesh using data from a survey conducted by Microinsurance Research Unit (MRU) of the Institute of Microfinance (InM) of 4,010 households drawn from 120 villages. The study focuses on formal health care use over the 12 months preceding the survey. We use both the ‘need standardized’ approach and ‘decomposition analysis’ for measuring inequity. The paper finds that the use of formal health care is incredibly low (40%); about two-thirds (65%) of which is private health care and only one-fourth utilizes public sector facilities. Inequity in formal health care use favors the better-off although the level of inequity is modest. Prevailing inequity resides mainly in the utilization of private health care while NCDs contribute significantly to this inequity. Thus, the main public health concern in rural areas of Bangladesh is the low utilization of formal health care (especially public health care), not inequity. From a policy perspective therefore, voluntary health insurance is not an answer so far as chronic NCDs are concerned; social insurance is not quite feasible either due to the large informal economy. Hope therefore lies in the public provision of health care although the latter is plagued by various supply side constraints including meager budgetary resources, daunting governance issues and hence the need for reforms to enhance efficiency.