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Health-Related Financial Catastrophe, Inequality and Chronic Illness in Bangladesh

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  • Md Mizanur Rahman
  • Stuart Gilmour
  • Eiko Saito
  • Papia Sultana
  • Kenji Shibuya

Abstract

Background: Bangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP) payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk. Objective: This study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe. Methods: A cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively. Results: On average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults. Conclusion: Households that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by reducing the health system's dependency on OOP payments and providing more financial risk protection.

Suggested Citation

  • Md Mizanur Rahman & Stuart Gilmour & Eiko Saito & Papia Sultana & Kenji Shibuya, 2013. "Health-Related Financial Catastrophe, Inequality and Chronic Illness in Bangladesh," PLOS ONE, Public Library of Science, vol. 8(2), pages 1-9, February.
    • Handle: RePEc:plo:pone00:0056873
    DOI: 10.1371/journal.pone.0056873
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    1. Alayne M Adams & Rubana Islam & Sifat Shahana Yusuf & Anthony Panasci & Nancy Crowell, 2020. "Healthcare seeking for chronic illness among adult slum dwellers in Bangladesh: A descriptive cross-sectional study in two urban settings," PLOS ONE, Public Library of Science, vol. 15(6), pages 1-18, June.
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    3. Afroza Begum & Syed Abdul Hamid, 2021. "Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?," PLOS ONE, Public Library of Science, vol. 16(6), pages 1-21, June.
    4. M Trent Herdman & Richard James Maude & Md Safiqul Chowdhury & Hugh W F Kingston & Atthanee Jeeyapant & Rasheda Samad & Rezaul Karim & Arjen M Dondorp & Md Amir Hossain, 2016. "The Relationship between Poverty and Healthcare Seeking among Patients Hospitalized with Acute Febrile Illnesses in Chittagong, Bangladesh," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-21, April.
    5. Giovanis, Eleftherios & Ozdamar, Oznur, 2017. "The Effects of the 2008 Health Reform on Out-of-Pocket Health Expenditures in Turkey," MPRA Paper 95837, University Library of Munich, Germany.
    6. Swadhin Mondal & Henry Lucas & David Peters & Barun Kanjilal, 2014. "Catastrophic out-of-pocket payment for healthcare and implications for household coping strategies: evidence from West Bengal, India," Economics Bulletin, AccessEcon, vol. 34(2), pages 1303-1316.
    7. Tazeen Tahsina & Nazia Binte Ali & Md Abu Bakkar Siddique & Sameen Ahmed & Mubashshira Rahman & Sajia Islam & Md Mezanur Rahman & Bushra Amena & D M Emdadul Hoque & Tanvir M Huda & Shams El Arifeen, 2018. "Determinants of hardship financing in coping with out of pocket payment for care seeking of under five children in selected rural areas of Bangladesh," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-17, May.
    8. Wendy Janssens & Jann Goedecke & Godelieve J de Bree & Sunday A Aderibigbe & Tanimola M Akande & Alice Mesnard, 2016. "The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-19, November.
    9. Maryam Bigdeli & Bart Jacobs & Chean Rithy Men & Kristine Nilsen & Wim Van Damme & Bruno Dujardin, 2016. "Access to Treatment for Diabetes and Hypertension in Rural Cambodia: Performance of Existing Social Health Protection Schemes," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-18, January.
    10. Qun Wang & Alex Z Fu & Stephan Brenner & Olivier Kalmus & Hastings Thomas Banda & Manuela De Allegri, 2015. "Out-of-Pocket Expenditure on Chronic Non-Communicable Diseases in Sub-Saharan Africa: The Case of Rural Malawi," PLOS ONE, Public Library of Science, vol. 10(1), pages 1-15, January.
    11. Ebaidalla Mahjoub Ebaidalla & Mohammed Elhaj Mustafa Ali, 2017. "Determinants and Impact of Households’s Out-of-Pocket Health Care Expenditure in Sudan: Evidence From Urban and Rural Population," Working Papers 1170, Economic Research Forum, revised 12 2017.
    12. Nazmul Islam, Muhammed & Rabbani, Atonu & De Allegri, Manuela & Sarker, Malabika, 2024. "Medical treatment loans and their effects on health care utilization and out-of-pocket expenditure: Evidence from an experiment in northern Bangladesh," World Development, Elsevier, vol. 184(C).
    13. Mohammad Omar Mashal & Keiko Nakamura & Masashi Kizuki, 2016. "Hidden burden of non-medical spending associated with inpatient care among the poor in Afghanistan," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 61(6), pages 661-671, July.
    14. Sunil Rajpal & Abhishek Kumar & William Joe, 2018. "Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, 2014," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-17, February.
    15. R.M.N.N. Senavirathna & R.M.N.S. Senavirathna, 2023. "Healthcare Expenditures Across Household Headship and Expenditure Quintiles: Insights From a Household Survey," International Journal of Research and Innovation in Social Science, International Journal of Research and Innovation in Social Science (IJRISS), vol. 7(3), pages 117-131, March.
    16. Md Muhitul Alam & Md Israt Rayhan & Mohaimen Mansur, 2024. "From the local disparities to national realities: Mapping and multilevel modeling of catastrophic health expenditure in Bangladesh using HIES 2016," PLOS ONE, Public Library of Science, vol. 19(1), pages 1-24, January.

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