Assessing the incidence of catastrophic health expenditure and impoverishment from out-of-pocket payments and their determinants in Bangladesh: evidence from the nationwide Household Income and Expenditure Survey 2016.

Sayem Ahmed,Clas Rehnberg,Louis W Niessen,Ziaul Islam,Mohammad Wahid Ahmed,Md Zahid Hasan,Gazi Golam Mehdi,Jahangir A M Khan

doi:10.1093/inthealth/ihab015

Abstract

BackgroundOut-of-pocket (OOP) payments for healthcare have been increasing steadily in Bangladesh, which deteriorates the financial risk protection of many households.MethodsWe aimed to investigate the incidence of catastrophic health expenditure (CHE) and impoverishment from OOP payments and their determinants. We employed nationally representative Household Income and Expenditure Survey 2016 data with a sample of 46 076 households. A household that made OOP payments of >10% of its total or 40% of its non-food expenditure was considered to be facing CHE. We estimated the impoverishment using both national and international poverty lines. Multiple logistic models were employed to identify the determinants of CHE and impoverishment.ResultsThe incidence of CHE was estimated as 24.6% and 10.9% using 10% of the total and 40% of non-food expenditure as thresholds, respectively, and these were concentrated among the poor. About 4.5% of the population (8.61 million) fell into poverty during 2016. Utilization of private facilities, the presence of older people, chronic illness and geographical location were the main determinants of both CHE and impoverishment.ConclusionThe financial hardship due to OOP payments was high and it should be reduced by regulating the private health sector and covering the care of older people and chronic illness by prepayment-financing mechanisms.

Highlights

In response to the United Nations Sustainable Development Goals (SDGs), the government of Bangladesh expressed a willingness to work to achieve Universal Health Coverage (UHC), which includes health service coverage (SDG 3.8.1) and financial risk protection (SDG 3.8.2).[1,2] In recent years, Bangladesh has made remarkable progress in expanding coverage for essential public health interventions, such as immunization.[3]
The findings in this study indicate that attempts to achieve the financial risk protection target (SDG 3.8.2) deteriorated in 2016, which might have been influenced by increasing reliance on OOP payments for healthcare in Bangladesh
In 2017, Khan et al estimated that the incidence of catastrophic health expenditure (CHE) in 2010 was 14.2% and 9.7%

Summary

Introduction

In response to the United Nations Sustainable Development Goals (SDGs), the government of Bangladesh expressed a willingness to work to achieve Universal Health Coverage (UHC), which includes health service coverage (SDG 3.8.1) and financial risk protection (SDG 3.8.2).[1,2] In recent years, Bangladesh has made remarkable progress in expanding coverage for essential public health interventions, such as immunization.[3]. OOP payments are the primary source of healthcare financing in many low- and middle-income countries (LMICs), resulting in a financial burden on many households each year.[5,6] Globally, around 150 million people experience catastrophic health expenditure (CHE) each year, and about 100 million individuals fall into poverty because of such payments.[7] A majority (>90%) of impoverished people reside in LMICs.[5,7] the health systems of LMICs should aim to protect affected households from such payments to reduce the risk of impoverishment.[8] SDG 3.8.2 measures ‘the proportion of the population with large household expenditure on health as a share of total household expenditure or income’.9. Out-of-pocket (OOP) payments for healthcare have been increasing steadily in Bangladesh, which deteriorates the financial risk protection of many households

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Discussion

Conclusion