Abstract
BackgroundPredictors of high out-of-pocket household healthcare expenditure are essential for creating effective health system finance policy. In Bangladesh, 63.3% of health expenditure is out-of-pocket and born by households. It is imperative to know what determines household health expenditure. This study aims to investigate the predicting factors of high out-of-pocket household healthcare expenditure targeting to put forward policy recommendations on equity in financial burden.MethodsBangladesh household income and expenditure survey 2010 provides data for this study. Predictors of high out-of-pocket household healthcare expenditure were analyzed using multiple linear regressions. We have modeled non-linear relationship using logarithmic form of linear regression. Heteroscedasticity and multicollinearity were checked using Breusch-Pagan/Cook-Weishberg and VIF tests. Normality of the residuals was checked using Kernel density curve. We applied required adjustment for survey data, so that standard errors and parameters estimation are valid.ResultsPresence of chronic disease and household income were found to be the most influential and statistically significant (p < 0.001) predictors of high household healthcare expenditure. Households in rural areas spend 7% less than urban dwellers. The results show that a 100% increase in female members in a family leads to a 2% decrease in household health expenditure. Household income, health shocks in families, and family size are other statistically significant predictors of household healthcare expenditure. Proportion of elderly and under-five members in the family show some positive influence on health expenditure, though statistically nonsignificant.ConclusionsThe findings call for emphasizing prevention of chronic diseases, as it is a strong predictor of household health expenditure. Innovative insurance scheme needs to be devised to prevent household from being impoverished due to health shocks in the family. Policy makers are urged to design an alternative source of healthcare financing in Bangladesh to minimize the burden of high OOP healthcare expenditure.
Highlights
Predictors of high out-of-pocket household healthcare expenditure are essential for creating effective health system finance policy
This study considers the importance of household health expenditure analysis on health policy formulation
The results of multiple regression show that 10% increase in household income leads to a 2% increase in household healthcare expenditure holding all other variables constant in the model, and it is highly statistically significant at p < 0 · 001
Summary
Predictors of high out-of-pocket household healthcare expenditure are essential for creating effective health system finance policy. In Bangladesh, 63.3% of health expenditure is out-of-pocket and born by households. It is imperative to know what determines household health expenditure. This study aims to investigate the predicting factors of high out-of-pocket household healthcare expenditure targeting to put forward policy recommendations on equity in financial burden. Good health of a population is an important input for poverty reduction, economic growth and long term economic development [1]. Out-of-pocket (OOP) payments or household’s share of direct healthcare expenditure is a major component of health system finance in middle and low-income countries. The threat that OOP payments pose to household living standards is increasingly recognized as a major consideration in health system financing [1, 3]. There is a growing evidence that household being pushed into poverty or forced into deeper poverty when faced with substantial medical expenses [4]
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