Abstract
ObjectivesOut-of-pocket (OOP) payment is the major payment strategy for healthcare in Bangladesh, and the share of OOP expenditure has increased alarmingly. Dhaka is recognised as one of the fastest-growing megacities in the world. The objective of this study is to capture the self-reported illnesses among urban citizens and to identify whether and to what extent socioeconomic, demographic and behavioural factors of the population influence OOP healthcare expenditures.Subject and methodsThis study utilises cross-sectional survey data collected from May to August 2019 in urban Dhaka, Bangladesh. A total of 3,100 households were randomly selected. Simple descriptive statistics including frequencies, percentage, mean (95% CI), median and inter-quartile range were presented. Bivariate analysis and multivariate regression models were employed.ResultsWe observed that acute illnesses (e.g., fever, flu/cough) were dominant among participants. Among the chronic illnesses, approximately 9.6% of people had diabetes, while 5.3% had high/low blood pressure. The richest quintile only spent 5.2% of their household income on healthcare, while the poorest households spent approximately six times more than the richest households. We noted that various factors such as marital status, religion, source of care, access to safe water, income quintile and even the location of households had a significant relationship with OOP expenditure.ConclusionsOur findings can serve as important source of data in terms of disease- specific symptoms and out-of-pocket cost among urban citizens in Dhaka. The people belonging to wealthier households tended to choose better healthcare facilities and spend more. A pro-poor policy initiative and even an urban health protection scheme may be necessary to ensure that healthcare services are accessible and affordable, in line with the Bangladesh National Urban Health Strategy.
Highlights
55% of the world’s population resided in urban areas in 2018, and at the end of the latest Agenda for Sustainable Development in 2030, the share of the urban population is expected to reach 60% [1, 2]
We observed that acute illnesses were dominant among participants
Our findings can serve as important source of data in terms of disease- specific symptoms and out-of-pocket cost among urban citizens in Dhaka
Summary
55% of the world’s population resided in urban areas in 2018, and at the end of the latest Agenda for Sustainable Development in 2030, the share of the urban population is expected to reach 60% [1, 2]. Living in urban areas offers many opportunities, notably potential access to better healthcare and better income, but unplanned and overpopulated urban environments tend to generate health risks and introduce new hazards [14, 15]. Those who migrate from rural to urban areas often alter the characteristics of the epidemiological disease profile of the country; new diseases appear or old ones re-emerge [16, 17]. The average income for the lowest 20% and the upper 20% were reported as 8,919 and 137,677 BDT, respectively, which shows a considerable difference
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