Abstract
BackgroundA central aim of Universal Health Coverage (UHC) is protection for all against the cost of illness. In a low income country like Bangladesh the cost burden of health care in tertiary facilities is likely to be significant for most citizens. This cost of an episode of illness is a relatively unexplored policy issue in Bangladesh. The objective of this study was to estimate an outpatient’s total cost of illness as result of treatment in private and public hospitals in Sylhet, Bangladesh.MethodsThe study used face to face interviews at three hospitals (one public and two private) to elicit cost data from presenting outpatients. Other socio-economic and demographic data was also collected. A sample of 252 outpatients were randomly selected and interviewed. The total cost of outpatients comprises direct medical costs, non-medical costs and the indirect costs of patients and caregivers. Indirect costs comprise travel and waiting times and income losses associated with treatment.ResultsThe costs of illness are significant for many of Bangladesh citizens. The direct costs are relatively minor compared to the large indirect cost burden that illness places on households. These indirect costs are mainly the result of time off work and foregone wages. Private hospital patients have higher average direct costs than public hospital patients. However, average indirect costs are higher for public hospital patients than private hospital patients by a factor of almost two. Total costs of outpatients are higher in public hospitals compared to private hospitals regardless of patient’s income, gender, age or illness.ConclusionOverall, public hospital patients, who tend to be the poorest, bear a larger economic burden of illness and treatment than relatively wealthier private hospital patients. The large economic impacts of illness need a public policy response which at a minimum should include a national health insurance scheme as a matter of urgency.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0458-x) contains supplementary material, which is available to authorized users.
Highlights
A central aim of Universal Health Coverage (UHC) is protection for all against the cost of illness
Out of pocket health expenditure by households totaled 64 % of direct costs with the rest coming from government and other sources [13]. This is an unreasonable burden for many households in a nation with an average per capita income of just on $US1000 per year [3]. This current study aims to inform policy makers about the costs, both direct and indirect, of outpatient treatment in public and private hospitals in one city in Bangladesh
Descriptive statistics A total of 252 respondents participated in this study with 139 attending the public hospital and 113 attending the two private hospitals
Summary
A central aim of Universal Health Coverage (UHC) is protection for all against the cost of illness. In a low income country like Bangladesh the cost burden of health care in tertiary facilities is likely to be significant for most citizens. This cost of an episode of illness is a relatively unexplored policy issue in Bangladesh. Over the past 20 years health care availability has increased as has the cost of treatment. According to the Bangladesh Bureau of Statistics [3] in 2010, 15 % of sick people were not treated due to their inability to pay for the (relatively) high cost of health care. Detailed cost of illness studies make a significant contribution to understanding the differential cost burden of illness [4, 5]
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