IDEAS home Printed from https://ideas.repec.org/a/spr/hecrev/v12y2022i1d10.1186_s13561-021-00348-6.html
   My bibliography  Save this article

Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis

Author

Listed:
  • Md. Mizanur Rahman

    (Hitotsubashi Institute for Advanced Study, Hitotsubashi University)

  • Md. Rashedul Islam

    (The University of Tokyo)

  • Md. Shafiur Rahman

    (Hamamatsu University School of Medicine)

  • Fahima Hossain

    (Global Public Health Research Foundation)

  • Ashraful Alam

    (The University of Tokyo)

  • Md. Obaidur Rahman

    (St. Luke’s International University)

  • Jenny Jung

    (Global Public Health Research Foundation)

  • Shamima Akter

    (Hitotsubashi Institute for Advanced Study, Hitotsubashi University)

Abstract

Background Ensuring access to health services for all is the main goal of universal health coverage (UHC) plan. Out-of-pocket (OOP) payment still remains the main source of funding for healthcare in Bangladesh. The association between barriers to accessing healthcare and over-reliance on OOP payments has not been explored in Bangladesh using nationally representative household survey data. This study is a novel attempt to examine the burden of OOP payment and forgone healthcare in Bangladesh, and further explores the inequalities in catastrophic health expenditures (CHE) and forgone healthcare at the national and sub-national levels. Methods This study used data from the most recent nationally representative cross-sectional survey, Bangladesh Household Income and Expenditure Survey, conducted in 2016–17 (N = 39,124). In order to identify potential determinants of CHE and forgone healthcare, multilevel Poisson regression was used. Inequalities in CHE and forgone healthcare were measured using the slope index of inequality. Results Around 25% of individuals incurred CHE and 14% of the population had forgone healthcare for any reasons. The most common reasons for forgone healthcare were treatment cost (17%), followed by none to accompany or need for permission (5%), and distance to health facility (3%). Multilevel analysis indicated that financial burden and forgone care was higher among households with older populations or chronic illness, and those who utilize either public or private health facilities. Household consumption quintile had a linear negative association with forgone care and positive association with CHE. Conclusion This study calls for incorporation of social safety net in health financing system, increase health facility, and gives priority to the disadvantaged population to ensure access to health services for all.

Suggested Citation

  • Md. Mizanur Rahman & Md. Rashedul Islam & Md. Shafiur Rahman & Fahima Hossain & Ashraful Alam & Md. Obaidur Rahman & Jenny Jung & Shamima Akter, 2022. "Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis," Health Economics Review, Springer, vol. 12(1), pages 1-11, December.
    • Handle: RePEc:spr:hecrev:v:12:y:2022:i:1:d:10.1186_s13561-021-00348-6
    DOI: 10.1186/s13561-021-00348-6
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1186/s13561-021-00348-6
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1186/s13561-021-00348-6?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184.
    2. Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan‐Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184, November.
    3. Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933, November.
    4. Nikoloski, Zlatko & Ajwad, Mohamed Ihsan, 2013. "Do economic crises lead to health and nutrition behavior responses?: analysis using longitudinal data from Russia," LSE Research Online Documents on Economics 51227, London School of Economics and Political Science, LSE Library.
    5. Nikoloski, Zlatko & Ajwad, Mohamed Ihsan, 2013. "Do economic crises lead to health and nutrition behavior responses ? analysis using longitudinal data from Russia," Policy Research Working Paper Series 6538, The World Bank.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Van Minh, Hoang & Kim Phuong, Nguyen Thi & Saksena, Priyanka & James, Chris D. & Xu, Ke, 2013. "Financial burden of household out-of pocket health expenditure in Viet Nam: Findings from the National Living Standard Survey 2002–2010," Social Science & Medicine, Elsevier, vol. 96(C), pages 258-263.
    2. Raúl Del Pozo-Rubio & Isabel Pardo-García & Francisco Escribano-Sotos, 2020. "Financial Catastrophism Inherent with Out-of-Pocket Payments in Long Term Care for Households: A Latent Impoverishment," IJERPH, MDPI, vol. 17(1), pages 1-19, January.
    3. Kim, Sujin & Kwon, Soonman, 2015. "Impact of the policy of expanding benefit coverage for cancer patients on catastrophic health expenditure across different income groups in South Korea," Social Science & Medicine, Elsevier, vol. 138(C), pages 241-247.
    4. A. Akhtar & Nadeem Ahmad & Indrani Roy Chowdhury, 2020. "Socio-economic inequality in catastrophic health expenditure among households in India: A decomposition analysis," Indian Economic Review, Springer, vol. 55(2), pages 339-369, December.
    5. Kyriopoulos, Ilias & Nikoloski, Zlatko & Mossialos, Elias, 2021. "Financial protection in health among the middle-aged and elderly: Evidence from the Greek economic recession," Health Policy, Elsevier, vol. 125(9), pages 1256-1266.
    6. Maria-Carmen García-Centeno & Román Mínguez-Salido & Raúl del Pozo-Rubio, 2021. "The Classification of Profiles of Financial Catastrophe Caused by Out-of-Pocket Payments: A Methodological Approach," Mathematics, MDPI, vol. 9(11), pages 1-20, May.
    7. Chen, Mingsheng & Xu, Lizheng & Si, Lei & Wang, Zhonghua & Jan, Stephen, 2023. "Examining the level and distribution of catastrophic health expenditure from 2013 to 2018: A province-level study in China," Economic Modelling, Elsevier, vol. 121(C).
    8. Chantzaras, Athanasios E. & Yfantopoulos, John N., 2018. "Financial protection of households against health shocks in Greece during the economic crisis," Social Science & Medicine, Elsevier, vol. 211(C), pages 338-351.
    9. Somkotra, Tewarit & Lagrada, Leizel P., 2008. "Payments for health care and its effect on catastrophe and impoverishment: Experience from the transition to Universal Coverage in Thailand," Social Science & Medicine, Elsevier, vol. 67(12), pages 2027-2035, December.
    10. Thuong, Nguyen Thi Thu, 2021. "Catastrophic health expenditure and impoverishment in Vietnam: Evidence from national Household Living Standards Surveys 2008–2018," Economic Analysis and Policy, Elsevier, vol. 72(C), pages 668-684.
    11. Rahman, Md Mizanur & Jung, Jenny & Islam, Md Rashedul & Rahman, Md Mahfuzur & Nakamura, Ryota & Akter, Shamima & Sato, Motohiro, 2022. "Global, regional, and national progress in financial risk protection towards universal health coverage, 2000–2030," Social Science & Medicine, Elsevier, vol. 312(C).
    12. repec:eid:wpaper:3/09 is not listed on IDEAS
    13. Kim, Chang-O & Joung, Won Oh, 2014. "Effect of the Crisis Assistance Program on poverty transition for seriously ill people in South Korea: A quasi-experimental study," Social Science & Medicine, Elsevier, vol. 101(C), pages 28-35.
    14. Rama Pal, 2012. "Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India," International Journal of Health Economics and Management, Springer, vol. 12(1), pages 63-85, March.
    15. Hyunwoo Jung & Junhyup Lee, 2021. "Estimating the effectiveness of national health insurance in covering catastrophic health expenditure: Evidence from South Korea," PLOS ONE, Public Library of Science, vol. 16(8), pages 1-20, August.
    16. Richard Mussa, 2016. "Exit from catastrophic health payments: a method and an application to Malawi," International Journal of Health Economics and Management, Springer, vol. 16(2), pages 163-174, June.
    17. Chaudhuri, Anoshua & Roy, Kakoli, 2008. "Changes in out-of-pocket payments for healthcare in Vietnam and its impact on equity in payments, 1992-2002," Health Policy, Elsevier, vol. 88(1), pages 38-48, October.
    18. Halil D. Kaya, 2016. "How do Economic Crises Affect Regional Human Development? An Investigation of the 2008 Global Crisis," International Journal of Academic Research in Business and Social Sciences, Human Resource Management Academic Research Society, International Journal of Academic Research in Business and Social Sciences, vol. 6(6), pages 138-149, June.
    19. Navneet Manchanda & Dil Bahadur Rahut, 2021. "Inpatient Healthcare Financing Strategies: Evidence from India," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 33(6), pages 1729-1767, December.
    20. Ahmad Reshad Osmani & Albert Okunade, 2021. "A Double-Hurdle Model of Healthcare Expenditures across Income Quintiles and Family Size: New Insights from a Household Survey," JRFM, MDPI, vol. 14(6), pages 1-21, May.
    21. Ramses H. Abul Naga & Karine Lamiraud, 2008. "Catastrophic Health ExpenditureandHousehold Well-Being," STICERD - Distributional Analysis Research Programme Papers 098, Suntory and Toyota International Centres for Economics and Related Disciplines, LSE.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:hecrev:v:12:y:2022:i:1:d:10.1186_s13561-021-00348-6. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com/economics/journal/13561 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.