Healthcare-Seeking Behavior and Out-of-Pocket Payments in Rural Bangladesh: A Cross-Sectional Analysis

Abstract

This study investigates the determinants of patient’s choice of treatment (i.e., modern vs. alternative healthcare) using Bangladesh’s Household Income and Expenditure Survey (HIES) dataset for exploring their healthcare-seeking behavior and the extent of out-of-pocket (OOP) payment due to illnesses. It explores this issues using the descriptive statistics, bivariate analysis like analysis of variance (ANOVA) and Chi-square test as well as econometric modeling (probit regression model on modern healthcare utilization for the full sample as well as for each quintile). All these help to identify the determinants of healthcare-seeking behavior in rural Bangladesh and how these vary across the quintiles of expenditure on food consumption. This study finds that higher percentage of healthcare-seeking patients receives alternative healthcare because of the lower cost and easier access compared to modern healthcare. The marginal effects of the predisposing factors like patient’s age, parent’s literacy, mother’s age, house with separate dining room, access to electricity and mobile are significantly positive, which means these are more likely to influence modern healthcare utilization. In contrast, the marginal effects of the enabling factors like income, landholdings, access to social benefit are positive, but insignificant. Therefore, predisposing factors rather than enabling factors play crucial role in determining choice of modern treatment in rural Bangladesh. In addition, variations in the marginal effects exist across different groups based on regression by quintile. Finally, sickness prevalence as well as modern healthcare utilization also varies across geographic regions. The average OOP payment is higher for modern healthcare compared to alternative one and it remains true after disaggregation of OOP expenditure. Disease-specific OOP using first-difference method is also positive for all diseases (i.e., OOP expenditure for modern healthcare> OOP expenditure for alternative healthcare) and most of the first-difference estimates are statistically significant. Similar tendencies are also observed in case of applying distributional analysis using quintiles. All these are important for formulating a national health policy for the rural people in Bangladesh. At last, a special attention to expanding utilization of modern healthcare is required for young mothers, elderly household head and the patients belong to minority group in rural Bangladesh.