Household Income And Expenditure Survey Research Articles

Dietary changes during the COVID-19 lockdown in Iranian households: are we witnessing a secular trend? A narrative review.

The COVID-19 pandemic, which emerged in late 2019, influenced nearly all aspects of human life, including food choices and dietary habits. A web-based search was conducted from March to April 2024 in MEDLINE/PubMed, CINAHL, Embase, and the Cochrane Library for published reports of large-scale surveys of dietary changes during or shortly after the coronavirus pandemic lockdown in Iran. The keywords used were coronavirus OR COVID-19, diet OR nutrition, household, and Iran. Studies that focused on specific areas, subgroups (such as students), or just one city or province were not included. To monitor dietary changes from the years before the lockdown, we used and plotted data from the Household Income and Expenditure Survey (HIES), as provided by the Statistical Center of Iran. The overall results of the nationwide studies conducted during the lockdown period in Iran revealed that a significant proportion of the households reduced their consumption of milk, yogurt, cheese, red meat, white meat, eggs, and rice/bread. In approximately 47% of the households where weekly consumption of animal protein sources decreased, the consumption of rice and bread increased. Accordingly, 35 and 44% of households reported a decrease in the consumption frequency of fruits and snacks, respectively. Additionally, 21% of those who reduced their fruit consumption completely removed fruits from their food basket. Meanwhile, the use of dietary supplements, especially vitamin D, vitamin C, zinc, and multivitamins, had increased in households, particularly among those with higher incomes. Decreased income was a common reason for all of these dietary changes, which can have major health consequences in the long term. This review provides evidence that the observed changes had already begun years before the pandemic and presumably have not yet returned to the pre-pandemic situation. Finally, we suggest some strategies for policymakers to overcome the crisis and enhance community the nutrition and health of general population.

Cost-effectiveness of tax policies on promoting sustainable diets in Iran: a modeling study.

Implementation of food taxes may promote sustainable diets in a society. This study estimates the potential short-term impacts of taxes on sugar and sweets (SAS), sugar sweetened beverages (SSB) and hydrogenated oil and animal fats (HOAF) in Iran through a social cost-effectiveness analysis. In this study, three tax scenarios were evaluated, including a 25% tax on SASs, a 30% tax on SSBs, and a 30% tax on HOAFs. The data from Iran's 2019-2020 Household Income and Expenditure Survey (HIES) were utilized, and a simulated population of 1 million individuals aged over 25 years was analyzed. Population impact fraction (PIF) was calculated to estimate the averted number of cases and Disability-Adjusted Life Years (DALYs) under each policy scenario. Additionally, the study assessed water and carbon footprints, as well as all associated costs. Cost-effectiveness was evaluated through incremental cost-effectiveness ratios (ICER) and comparison with WHO-recommended thresholds. Implementation of taxes on SASs and HOAFs resulted in reductions of 1.09 and 1.08% in water footprint, as well as 0.47 and 1.05% in carbon footprint, respectively. In terms of population health, the interventions resulted in averting 343.92 DALYs (95% UI = 318.62-369.36) for the SSB tax and 1219.01 DALYs (95% UI = 1123.05-1315.77) for the tax on HOAFs. Additionally, the tax on SASs averted 1028.09 DALYs (95% UI = 947.16-1,109). All scenarios were deemed cost-effective based on the WHO threshold for ICER, with values of 0.26 billion Rials/DALY, 0.54 billion Rials/DALY, and 0.17 billion Rials/DALY, respectively. The studied tax scenarios could generate substantial health gains and be cost-effective in Iran. It is recommended that policymakers consider implementing such price policies to promote healthy and sustainable diets.

The effects of mother's schooling on next generation’s schooling: evidence from Bangladesh

PurposeThis paper aims to find the effects of mothers’ schooling on child schooling.Design/methodology/approachThis paper uses Bangladesh's Household Income and Expenditure Survey (HIES), which is a nationally representative survey. It employs the instrumental variable technique to estimate the intergenerational model.FindingsInterestingly, the results show that the intergenerational transmission of schooling from mothers is slightly higher than that of fathers in Bangladesh.Research limitations/implicationsEstimating the intergenerational model is challenging due to the endogeneity issue. The methodology used in this paper may help to find similar evidence from other countries.Practical implicationsThe findings of the study may help to design and evaluate the educational policies in Bangladesh or a country like Bangladesh. For instance, the results of this paper suggest that the female stipend program (FSP) in Bangladesh is effective for the next generation’s schooling.Originality/valueThis paper is among the first to analyze the effect of mother’s schooling on the child’s schooling, controlling the father’s education and other household characteristics. In addition, it controls for endogeneity bias due to genetic transmission.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-06-2023-0491

Catastrophic Health Expenditure among Iranian Households: Evidence from the COVID-19 Era.

Monitoring households' exposure to catastrophic health expenditure (CHE) based on out-of-pocket (OOP) health payments is a critical tool for evaluating the equitable financial protection status within the health system. The COVID-19 pandemic has brought unprecedented global change and potentially affected the mentioned protection indicators. This study aimed to assess the prevalence of CHE among households in Iran during the COVID-19 period. The present study employed a retrospective-descriptive design utilizing data derived from two consecutive cross-sectional Annual Household Income and Expenditure Surveys (HIES) undertaken by the Statistical Centre of Iran (SCI) in 2020 and 2021. The average annual OOP health payments and the prevalence of households facing CHE were estimated separately for rural and urban areas, as well as at the national level. Based on the standard method recommended by the World Health Organization (WHO), CHE was identified as situations in which OOP health payments surpass 40% of a household's capacity to pay (CTP). The intensity of CHE was also calculated using the overshoot measure. All statistical analyses were carried out using Excel-2016 and Stata-14 software. The average OOP health payments increased in 2021, compared to 2020, across rural and urban areas as well as at the national level. Urban residents consistently experienced higher OOP health payments than rural residents and the national level in both years. At the national level, the prevalence of CHE was 2.92% in 2020 and increased to 3.18% in 2021. In addition, rural residents faced a higher prevalence of CHE based on total health services OOP, outpatient services OOP, and inpatient services OOP compared to urban residents and the national level. Regarding the intensity of CHE using overshoot, the results for 2020 and 2021 revealed that the overshoot ranged between 0.60% and 0.65% in rural areas, between 0.30% and 0.33% in urban areas, and between 0.38% and 0.41% at the national level. A considerable percentage of households in Iran still incur CHE. This trend has increased in the second year of COVID-19 compared to the first year, as households received more healthcare services. The situation is even more severe for rural residents. There is an urgent need for targeted interventions in the health system, such as strengthening prepayment mechanisms, to reduce OOP and ensure equitable protection for healthcare recipients.

Age and sex-specific disability-free life expectancy in urban and rural settings of Bangladesh

BackgroundDisability-free life expectancy (DFLE) has been used to gain a better understanding of the population’s quality of life.ObjectivesThe authors aimed to estimate age and sex-specific disability-free life expectancy (DFLE) for urban and rural areas of Bangladesh, as well as to investigate the differences in DFLE between males and females of urban and rural areas.MethodsData from the Bangladesh Sample Vital Statistics-2016 and the Bangladesh Household Income and Expenditure Survey (HIES)-2016 were used to calculate the disability-free life expectancy (DFLE) of urban and rural males and females in Bangladesh in 2016. The DFLE was calculated using the Sullivan method.ResultsWith only a few exceptions, rural areas have higher mortality and disability rates than urban areas. For both males and females, statistically significant differences in DFLE were reported between urban and rural areas between the ages of birth and 39 years. In comparison to rural males and females, urban males and females had a longer life expectancy (LE), a longer disability-free life expectancy, and a higher share of life without disability.ConclusionThis study illuminates stark urban–rural disparities in LE and DFLE, especially among individuals aged < 1–39 years. Gender dynamics reveal longer life expectancy but shorter disability-free life expectancy for Bangladeshi women compared to men, emphasizing the need for targeted interventions to address these pronounced health inequalities.

Own price elasticities of the demand for sugar-sweetened beverages in Bangladesh

BackgroundConsumption of sugar-sweetened beverages (SSB) is a major global public health problem. Increasing the price of SSBs through taxation is an effective tool to reduce SSB consumption. Price-elasticity estimates are useful in measuring the effect of taxation on consumption. We estimated the own price elasticities of demand for SSBs in Bangladesh, which will inform how SSB taxes could affect behaviour.MethodsWe used Household Income and Expenditure Survey (HIES) 2016 data, which is a nationally representative dataset at the household level across the country and is conducted using stratified random sampling method. Deaton’s method was used to estimate the price elasticities for SSBs in Bangladesh.ResultsWe found that the own price elasticity for SSBs varied between − 0.53% to -1.17% by types of SSBs in Bangladesh. The price elasticity for soft drinks was − 1.17, indicating that if the price of soft drinks increases by 10% via taxes, the quantity consumed of these beverages would reduce by 11.7%.ConclusionThis is the first study that estimates the own price elasticities of demand for SSBs in Bangladesh. Our results suggest to raise SSB prices through increased taxation in order to reduce SSB consumption and ensure public health gains in Bangladesh.

Effect of the Social Safety Net on Child Labor and School Retention in Bangladesh: Empirical Evidence from Hies 2016

ABSTRACT: In Bangladesh Social Safety Net (SSN) interventions are intended to achieve specific goals, e.g., reduction in poverty, decrease in early school dropout, and nutrition supplementation. This study investigates the effectiveness of SSN participation on less explored goals of child labor reduction and school retention in Bangladesh. Empirical evidence is provided to evaluate the success of existing programs to combat child labor and early school dropout. This study utilizes the Household Income and Expenditure Survey (HIES), 2016 of Bangladesh. We employ the Propensity Score Matching (PSM) framework to show the causal relationship between SSN participation and its impact on the use of child labor and school retention. Given the nature and availability of data, the matching method provides us an estimate of the impact of SSN based on a quasi-experimental setting. We estimate counterfactuals based on observed characteristics of the household that affect both SSN participation and our outcome variables. Our results suggest that households that receive SSN tend to employ less child labor domestic or paid compared to their counterparts. Our Propensity Score Matching (PSM) results show that SSN participation reduces child labor prevalence in Bangladesh by 2.4% to 2.9%. This is an indication that families essentially substitute SSN income with child labor earnings. Thus, SSN programs in Bangladesh are effective in reducing child labor though the magnitude is not overwhelming. On the contrary, our results show that children from SSN-participating families have a higher incidence of early school dropout. This may be due to inefficiency or poorly designed programs that effectively keep the children in school. We estimate early school dropout is higher by 3.6% to 6.6% for households that receive SSN compared to the control group. Our findings are important for policymakers to redesign the programs that retain children in school. We suggest targeted interventions that will help to keep these children in school, which is conducive to human capital accrual and increasing lifetime earnings. Additionally, our insights will assist policymakers in rethinking SSN coverage, efficient selection of beneficiaries, and initiation of the correct intervention.

Measuring Poverty and its Associated Factors in Different Backward Regions of Bangladesh

Poverty is one of the major problems for a developing country and it is much more complex in the backward regions such as Monga, Haor, Char, Hilly, Costal areas, etc. Because of the complexity of this problem, governments often fail to execute proper policies to get rid of poverty in these regions. Thus, the present study aims to discuss the poverty measurement technique being used in and the factors associated with poverty in these regions. The data for this study is extracted from Household Income and Expenditure Survey (HIES) 2010, conducted by Bangladesh Bureau of Statistics (BBS). Poverty in Bangladesh was earlier measured by direct calorie intake (DCI) method. The food energy intake (FEI) method was first used in the Poverty Monitoring Survey 1995. The cost of basic need (CBN) method is used in this study to measure poverty which was first used in HIES 1995-1996 and then in HIES-2000. Besides, two-level binary logistic regression is used to identify the factors associated with poverty. The analyses found that the households of the regions Monga, Haor, Hilly, Char and Costal areas were below upper poverty line (poor) were 79%, 50%, 48%, 66%, and 39% respectively and the households of the regions Monga, Haor, Hilly, Char and Costal areas were below lower poverty line (extreme poor) were 68%, 37%, 30%, 53%, and 26% respectively. The potential factors having significant association with poverty were found to be age and education of household head, specific region, household size, household types, number of dependents, per capita income, household own land, access to electricity, amount of cultivable land, engagement in livestock, engagement in fishing and farm forestry, household non-agricultural assets, remittance receiving from outside, number of male and female earner in the family.

Impact of Targeted Subsidies Reform on Household Nutrition: Lessons Learned from Iran.

In 2010, Iran became the first major oil-exporting country to reduce substantially implicit energy subsidies by increasing domestic energy and agricultural prices by up to 20 times. The current research aims to evaluate the profound impact of the countywide implementation of this targeted subsidy reform (TSR) on the consumption patterns of households in Iran, specifically in relation to the consumption of healthy food commodities. This study employed a robust approach to examine the impact of the TSR on household food consumption, as a natural experiment, using pooled cross-section data from the Household Income and Expenditure Survey (HIES) spanning the years 1992 to 2019. The analysis was based on a comprehensive interpretation of survey data, which served as the primary source for analysis. The estimation procedure utilized an interrupted time series (ITS) model to capture the parameters associated with food consumption. The findings revealed a substantial increase in household expenditures on food immediately following the policy intervention, with an impressive rise of 823 thousand Rials (equivalent to approximately $6.36 based on the floating exchange rate in 2019). Furthermore, the results strongly indicate a significant annual upward trend in total monthly food expenditures per adult person, surpassing the pre-intervention trend by 441 thousand Rials (approximately $3.40) (P=0.044, CI=[12.86, 1016.81]). Moreover, the implementation of the policy led to an annual per capita increase in fruit consumption by 1.02 grams per day (P=0.225, CI=[-0.68; 2.72]). This study shows that the initial positive effects of the TSR have gradually been eroded by inflation in subsequent years. This experience can serve as a lesson for all countries that TSR should be accompanied by other measures, such as poverty alleviation interventions, in order to achieve desired long-term results.

The crowding-out effect of sugar-sweetened beverages (SSBs) on household expenditure patterns in Bangladesh

BackgroundConsumption of sugar-sweetened beverages (SSBs) or sugary drinks may reduce or even eliminate the household income allocation for other essential commodities. Reducing expenditure for consumption of other household commodities is known as the crowding-out effect of SSB. We aimed to determine the crowding-out effect of SSB expenditure on other household commodities. In addition, we also identified the factors influencing the household's decision to purchase of SSBs.MethodsWe used the logistic regression (logit and multinomial logit models) and the Seemingly Unrelated Regression (SUR) models. In order to find the probability of a given change in the socio-demographic variables, we also estimated the average marginal effects from the logistic regression. In addition, we regressed the SUR model by gender differences. We used Household Income and Expenditure Survey (HIES) 2016 data to estimate our chosen econometric models. HIES is nationally representative data on the household level across the country and is conducted using a multistage random sampling method by covering 46,075 households.ResultsThe findings from the logit model describe that the greater proportion of male members, larger household size, household heads with higher education, profession, having a refrigerator, members living outside of the house, and households with higher income positively affect the decision of purchasing SSB. However, the determinants vary with the various types of SSB. The unadjusted crowding out effect shows that expenditure on SSB or sugar-added drinks crowds out the household expenditure on food, clothing, housing, and energy items. On the other hand, the adjusted crowding out effect crowds out the spending on housing, education, transportation, and social and state responsibilities.ConclusionAlthough the household expenditure on beverages and sugar-added drinks is still moderate (around 2% of monthly household expenditure), the increased spending on beverages and sugar-added drinks is a concern due to the displacement of household expenditure for basic commodities such as food, clothing, housing, education, and energy. Therefore, evidence-based policies to regulate the sale and consumption of SSB are required for a healthy nation.

Evaluating the mediating role of energy subsidies on social well-being and energy poverty alleviation in Bangladesh

Energy subsidies are a widespread policy instrument employed by national governments to regulate the mechanism of energy resource allocation in contemporary market economies. The economic impact of these subsidies has been quantitatively evaluated for various nations in the literature using different approaches. However, the impact of energy subsidies on social wellbeing tracked by looking at school drop-out, health status, and earning capacity through mediating effects of energy poverty employing mediation analysis using household-level data is rarely investigated, particularly for energy-poor countries. Thus, by employing mediation analysis with data from three waves of the national Household Income and Expenditure Survey (HIES) of Bangladesh for the years 2005, 2010, and 2016, this study intends to reveal the mediating effects of energy subsidies on social wellbeing via energy poverty. The results obtained utilizing a mixed-effect regression approach suggest that energy subsidies and energy poverty are significantly linked, and energy subsidies improve social wellbeing by mediating effects of energy poverty. This finding is robust to alternative ways of addressing endogeneity using Lewbel's two-stage least squares (2SLS) method. Additionally, the richer households realize better social wellbeing and have less energy poverty, gaining more than other households from energy subsidies. The policy relevance of this paper advocates further innovation in energy subsidy reforms in energy-poor countries for combating energy poverty and ensuring clean, sustainable, and affordable energy for all in line with the aims of the sustainable development goals (SDGs) 7, affordable and clean energy.

Do remittances reduce school dropout in Bangladesh? The role of government’s administrative and structural support

In the development literature, the impact of remittances on educational outcomes is a contentious topic and remains at the heart of policy discussions on enhancing quality education in developing countries. Bangladesh being one of the world’s top remittance recipients, it’s crucial to understand the influence of remittances on educational outcomes and school dropout rates. In this study, we examine the impact of internal remittances (from inside Bangladesh) and international remittances (from outside Bangladesh) on school dropout at the household level using a unique, national, and two most recent datasets covering migration and remittance-related information from the Bangladesh Household Income and Expenditure Survey (HIES). Considering the methodological issues such as endogeneity sources and self-selection, we used the Instrumental Variable Cox Proportional Hazard model and included asset scores in the models as a proxy measure of households’ wealth index. Furthermore, all the outcomes using the econometric approaches were segregated into three groups: i) those who received no remittances, ii) those who received internal remittances, and iii) those who received international remittances for both HIES 2010 and HIES 2016. This analysis provides a critical picture of the influence of remittances on school dropouts in Bangladesh by giving us a significant positive outcome of the remittances as a whole on education. With the increase in remittance inflows in Bangladesh, the risk of children aged 6-18 dropping out of education are more likely to fall. Aside from the positive impact, this study suggests that government should take the initiative of reducing the costs of sending remittances to Bangladesh. Moreover, the government should provide procedural and structural support to migrants.

Socioeconomic inequality in informal payments for health services among Iranian households: a national pooled study

BackgroundThere is limited evidence on the prevalence and socioeconomic inequality in informal payments (IP) of households in the Iranian health system. This study was conducted to investigate the prevalence of IP and related socioeconomic inequalities among Iranian households in all provinces.MethodData on Household Income and Expenditure Surveys (HIES) for 91,360 households were used to examine the prevalence and inequality in informal health sector payments in the years 2016 to 2018. The Normalized Concentration Index (NC) was used to examine inequality in these payments and the decomposition analysis by the Wagstaff approach was used to determine the share of variables affecting the measured inequality.ResultsOf the total households, 7,339 (7.9%) reported IP for using health services. Urban households had higher IP (10%) compared to rural ones (5.42%). Also, the proportion of households with IP in 2016 (11.69%) was higher than in 2017 (9.9%), and 2018 (4.60%). NC for the study population was 0.129, which shows that the prevalence of IP is significantly higher in well-off households. Also, NC was 0.213 (p < 0.0001) and -0.019 for urban and rural areas, respectively (p > 0.05). Decomposition analysis indicated that income, sex of head of household, and the province of residence have the highest positive contribution to measured inequality (with contributions of 156.2, 45.8, and 25.6%, respectively).ConclusionThere are a significant prevalence and inequality in IP in Iran's health system and important variables have shaped it. On the whole, inequality was pro-rich. This may lead to increasing inequality in access to quality services in the country. Our findings showed that previous health policies such as regulatory tools, and the health transformation plan (HTP) have not been able to control IP in the health sector in the desired way. It seems that consumer-side policies focusing on affluent households, and high-risk provinces can play an important role in controlling this phenomenon.

Cost of Recommended Diet (CoRD) and Its Affordability in Bangladesh.

The cost of diet has been recognized as a major determinant of overall diet quality and nutritional outcomes. We aimed to estimate the minimum cost and affordability of the recommended diet based on the updated food-based dietary guidelines (FBDG) in Bangladesh. To compute the cost of the recommended diet (CoRD), we collected retail prices of foods corresponding to each of the food groups in the latest Bangladeshi FBDG. For affordability, the household size and daily food expenditure data were used from the most recent Household Income and Expenditure survey (HIES). The CoRD was calculated based on the average number of servings recommended for each food group; the CoRD was adjusted by a deflation factor and divided by the household's daily food expenditure to estimate affordability. We found that the CoRD was $0.87 (83 BDT) per person per day at the national level. Nationally, about 43% of households could not afford the CoRD, with rural areas bearing a disproportionate share of the burden. We also found households to overspend on starchy staples while underspending on protein-rich foods, fruits, and dairy. These findings highlight the need for immediate implementation of interventions to improve the affordability of the CoRD and redesign policy instruments to create a sustainable food system.

Assessing the Cultural Impact of the Equal Distribution Policy (EDIP) on iTaukei: A Blessing or a Curse?

The iTaukei, or Indigenous people of Fiji, own 91 per cent of the land and makeup 57 per cent of the country’s multiracial population. Although critical in development discourses, these figures do not appear to translate into the development outcomes for the biggest landowners in the country. As it is, the 2019-2020 Household Income and Expenditure Survey (HIES) revealed that 75 per cent of those living below the Basic Needs Poverty Line were iTaukei, the highest of all the ethnic groups living in Fiji (Fiji Bureau of Statistics, 2021). This statistic challenges the previous government’s rhetoric: ‘We are leaving no one behind.’ In 2010, the Bainimarama government amended the Leases and Licenses Regulations of the Native Land Act (1961) to ensure equal distribution of lease money to members of landowning units (LOUs) who lease their lands. There were claims of social, economic, and cultural benefits made by the Bainimarama government that were endorsed by the iTaukei Native Land Trust Board (TLTB) to validate the amendments. This article critically examines the government’s claims concerning EDIP to protect customary practices. The discussions are based on empirical evidence from a case study that examines the implications of land law literacy on village governance, political affiliations and the well-being of iTaukei in Narewa, western Viti Levu.

Trends in Inequality in Pakistan between 1998-99 and 2001-02

Although there has been a much debate on poverty in Pakistan in recent time, the discussion on inequality remained limited. Poverty and inequality are closely linked—for a given mean income, the more unequal the income distribution, the larger the percentage of the population living in income poverty. Thus, incomes at the top and in the middle of the distribution may be just as important to us in perceiving and measuring poverty as those at the bottom. It is, thus, important to monitor the whole income distribution rather than merely the bottom of distribution. The issue of income inequality in Pakistan has been important in the policy discussions since the early 1960s. Since then, a number of attempts have been made to estimate the income or expenditure inequality using the Household Income and Expenditure Survey (HIES) data. However, a perception of increasing absolute poverty in Pakistan has shifted the focus of studies from inequality (or relative poverty) to absolute poverty. Consequently, a number of attempts have been made by various authors/institutions to estimate the poverty in Pakistan in the 1990s. The debate on trends in poverty during the 1990s—an era of stabilisation and structural adjustment has been wide-ranging in Pakistan. However, there is no discussion on the changes in income distribution from the policy and institutional reforms. World Bank (2003); FBS (2001) and Kemal (2003) are only three exceptions. While the former two studies report Gini Coefficients in their studies on absolute poverty in Pakistan without explaining its variations over time, the latter study is a comprehensive review on the income distribution in Pakistan.

Out-of-pocket expenditure on medicines in Bangladesh: An analysis of the national household income and expenditure survey 2016-17.

High out-of-pocket expenditures (OOPE) increases the probability that households will become impoverished or will forgo needed care. The aim of this paper is to study household medicines expenditure and its associated determining factors to develop policies to protect households from financial hardship. The present cross-sectional and population-level study used the Bangladesh 2016-17 National Household Income and Expenditure Survey (HIES). The final sample size was 46,080 households. We analyzed the probability of OOPE for medicines, the share of total OOPE due to medicines out of total OOPE in health (reported as a ratio between zero and one), the OOPE amount for medicines reported (in United States Dollars), and the share of OOPE amount on medicines out of total household expenditure (reported as a ratio between zero and one). Predictors of analyzed outcomes were identified using three regression models. Out of those households who spent on healthcare, the probability of having any OOPE on medicines was 87.9%. Of those who spent on medicines, the median monthly expenditure was US$3.03. The poorest households spent 9.97% of their total household expenditure as OOPE on medicines, nearly double that of the wealthiest households (5.86%). The characteristic which showed the most significant correlation to a high OOPE on medicines was the presence of chronic diseases, especially cancer. Twenty six percent of all surveyed households spend more than 10% of their OOPE on medicines. Our study shows that financial protection should be targeted at the poorest quintiles and such protection should include enrollment of rural households. Further, outpatient medicines benefits should include those for non-communicable diseases (NCDs).

Remittances and multidimensional energy poverty: Evidence from a household survey in Bangladesh

This paper explores the impact of remittances on multidimensional energy poverty in Bangladesh by employing a nationally representative Household Income and Expenditure Survey (HIES)-2016 with a sample size of 46,080 households. Remittance is one of the sources of household income that can be utilized for energy services. Energy poverty is generally described and quantified at the household level, exposing potential household characteristics in terms of energy costs and benefits and access to energy services. Controlling for the relevant characteristics of investigated households, mixed-effect linear regression, two-stage least square, and generalized ordered logistic regression reveal that households with remittance income have a significantly lower level of multidimensional energy poverty in Bangladesh. The outcomes of this work advocate that an upsurge in remittance inflow engenders a strong contribution toward alleviating energy poverty in Bangladesh and likely in other developing nations. National programs should be established for devising policies to promote migrant workers, lowering energy costs at the household level, and investing remittance income into modern energy technologies to ensure and enhance access to clean energy sources.

Linking Internal Migration, Flow of Remittances and Household Wellbeing

Labor migration is usually considered as economically benefiting the household family members who are left behind through remittances. The extent of migration and remittances have shown significant growth however the empirical evidence on the casual impact of migration on economic status and wellbeing of those who are left behind is not well documented at the regional level in Pakistan. The study aimed to assess the impact of regional remittance flow on household economic status and wellbeing by using propensity score matching (PSM) technique. The first approach is to develop Multidimensional Poverty Index and second to show how pattern of inter and intra-provincial and regional remittances flow decreases the probability of poverty and affects the household wellbeing. For the analysis, the study utilized the nationally representative Pakistan Household Income and Expenditure Survey (HIES) 2013–2014. The results of the analysis lead to the conclusion that internal labor mobility occurs because of poverty, instead of benefitting the households who are left behind further had dragged them into risk of poverty. The poor individuals moving to urban or other areas in search of job opportunities had not been able to support themselves in new areas but also had failed to support their family back at home.

Disease-specific distress healthcare financing and catastrophic out-of-pocket expenditure for hospitalization in Bangladesh

BackgroundFinancial risk protection and equity are two fundamental components of the global commitment to achieve Universal Health Coverage (UHC), which mandates health system reform based on population needs, disease incidence, and economic burden to ensure that everyone has access to health services without any financial hardship. We estimated disease-specific incidences of catastrophic out-of-pocket health expenditure and distress financing to investigate progress toward UHC financial risk indicators and investigated inequalities in financial risk protection indicators by wealth quintiles. In addition, we explored the determinants of financial hardship indicators as a result of hospitalization costs.MethodsIn order to conduct this research, data were extracted from the latest Bangladesh Household Income and Expenditure Survey (HIES), conducted by the Bangladesh Bureau of Statistics in 2016–2017. Financial hardship indicators in UHC were measured by catastrophic health expenditure and distress financing (sale/mortgage, borrowing, and family support). Concentration curves (CC) and indices (CI) were estimated to measure the pattern and severity of inequalities across socio-economic classes. Binary logistic regression models were used to assess the determinants of catastrophic health expenditure and distress financing.ResultsWe found that about 26% of households incurred catastrophic health expenditure (CHE) and 58% faced distress financing on hospitalization in Bangladesh. The highest incidence of CHE was for cancer (50%), followed by liver diseases (49.2%), and paralysis (43.6%). The financial hardship indicators in terms of CHE (CI = -0.109) and distress financing (CI = -0.087) were more concentrated among low-income households. Hospital admission to private health facilities, non-communicable diseases, and the presence of chronic patients in households significantly increases the likelihood of higher UHC financial hardship indicators.ConclusionsThe study findings strongly suggest the need for national-level social health security schemes with a particular focus on low-income households, since we identified greater inequalities between low- and high-income households in UHC financial hardship indicators. Regulating the private sector and implementing subsidized healthcare programmes for diseases with high treatment costs, such as cancer, heart disease, liver disease, and kidney disease are also expected to be effective to protect households from financial hardship. Finally, in order to reduce reliance on OOPE, the government should consider increasing its allocations to the health sector.