Abstract
BackgroundBangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP) payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk.ObjectiveThis study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe.MethodsA cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively.ResultsOn average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults.ConclusionHouseholds that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by reducing the health system's dependency on OOP payments and providing more financial risk protection.
Highlights
The fundamental role of a healthcare system is to improve population health and to protect households from financial catastrophe associated with illness [1]
Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses
Our study expands on this methodology to include assessment of the incidence of catastrophic expenditure, which is a key measure of the extent of financial risk protection as it judges whether the existing health financing system is able to protect its residents from the consequences of OOP payments [26]
Summary
The fundamental role of a healthcare system is to improve population health and to protect households from financial catastrophe associated with illness [1]. The only two studies reporting overall incidence of catastrophic expenses in Bangladesh are multi-country studies that present contradictory findings because of data limitations and methodological differences [16,17]: one of them found a very low (1.2%) incidence of catastrophic expenditure [17], while the other found a very high incidence (15%) [16]. They did not explore variations in OOP payments and catastrophic spending by healthcare facility, or by household or individual characteristics such as the presence of chronic illness. Identifying determinants of out-of-pocket (OOP) payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
