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Disease-specific out-of-pocket healthcare expenditure in urban Bangladesh: A Bayesian analysis

Author

Listed:
  • Md Mahfuzur Rahman
  • Cherri Zhang
  • Khin Thet Swe
  • Md Shafiur Rahman
  • Md Rashedul Islam
  • Md Kamrujjaman
  • Papia Sultana
  • Md Zakiul Hassan
  • Md Shahinul Alam
  • Md Mizanur Rahman

Abstract

Background: Because of the rapid increase of non-communicable diseases (NCDs) and high burden of healthcare-related financial issues in Bangladesh, there is a concern that out-of-pocket (OOP) payments related to illnesses may become a major burden on household. It is crucial to understand what are the major illnesses responsible for high OPP at the household level to help policymakers prioritize key areas of actions to protect the household from 100% financial hardship for seeking health care as part of universal health coverage. Objectives: We first estimated the costs of illnesses among a population in urban Bangladesh, and then assessed the household financial burden associated with these illnesses. Method: A cross-sectional survey of 1593 randomly selected households was carried out in Bangladesh (urban area of Rajshahi city), in 2011. Catastrophic expenditure was estimated at 40% threshold of household capacity to pay. We employed the Bayesian two-stage hurdle model and Bayesian logistic regression model to estimate age-adjusted average cost and the incidence of household financial catastrophe for each illness, respectively. Results: Overall, approximately 45% of the population of Bangladesh had at least one episode of illness. The age-sex-adjusted average medical expenses and catastrophic health care expenditure among the households were TK 621 and 8%, respectively. Households spent the highest amount of money 7676.9 on paralysis followed by liver disease (TK 2695.4), injury (TK 2440.0), mental disease (TK 2258.0), and tumor (TK 2231.2). These diseases were also responsible for higher incidence of financial catastrophe. Our study showed that 24% of individuals who suffered typhoid incurred catastrophic expenditure followed by liver disease (12.3%), tumor (12.1%), heart disease (8.4%), injury (7.9%), mental disease (7.9%), cataract (7.1%), and paralysis (6.5%). Conclusion: The study findings suggest that chronic illnesses were responsible for high costs and high catastrophic expenditures in Bangladesh. Effective risk pooling mechanism might reduce household financial burden related to illnesses. Chronic illness related to NCDs is the major cause of OOP. It is also important to consider prioritizing vulnerable population by subsidizing the high health care cost for some of the chronic illnesses.

Suggested Citation

  • Md Mahfuzur Rahman & Cherri Zhang & Khin Thet Swe & Md Shafiur Rahman & Md Rashedul Islam & Md Kamrujjaman & Papia Sultana & Md Zakiul Hassan & Md Shahinul Alam & Md Mizanur Rahman, 2020. "Disease-specific out-of-pocket healthcare expenditure in urban Bangladesh: A Bayesian analysis," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-11, January.
    • Handle: RePEc:plo:pone00:0227565
    DOI: 10.1371/journal.pone.0227565
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    References listed on IDEAS

    as
    1. 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.
    2. Anshul Kastor & Sanjay K Mohanty, 2018. "Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing?," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-18, May.
    3. Syed Abdul Hamid & Jennifer Roberts & Paul Mosley, 2011. "Can Micro Health Insurance Reduce Poverty? Evidence From Bangladesh," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 78(1), pages 57-82, March.
    4. Por Ir & Chean Men & Henry Lucas & Bruno Meessen & Kristof Decoster & Gerald Bloom & Wim Van Damme, 2010. "Self-Reported Serious Illnesses in Rural Cambodia: A Cross-Sectional Survey," PLOS ONE, Public Library of Science, vol. 5(6), pages 1-12, June.
    5. Khin Thet Swe & Md Mizanur Rahman & Md Shafiur Rahman & Eiko Saito & Sarah K Abe & Stuart Gilmour & Kenji Shibuya, 2018. "Cost and economic burden of illness over 15 years in Nepal: A comparative analysis," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-14, April.
    6. Jennifer Prah Ruger, 2012. "An Alternative Framework for Analyzing Financial Protection in Health," PLOS Medicine, Public Library of Science, vol. 9(8), pages 1-6, August.
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    1. Abdur Razzaque Sarker & S M Zulfiqar Ali & Maruf Ahmed & S M Zahedul Islam Chowdhury & Nausad Ali, 2022. "Out-of-pocket payment for healthcare among urban citizens in Dhaka, Bangladesh," PLOS ONE, Public Library of Science, vol. 17(1), pages 1-20, January.

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