Utilisation of Formal Health Care and Out-of-Pocket Payments in Rural Bangladesh
This paper provides an analysis of the utilisation of formal health care and out-ofpocket (OOP) payments in rural areas of Bangladesh. The broader focus of the investigation is to gauge how far Bangladesh has to traverse to achieve universal health coverage (UHC). We used the data from the baseline survey (conducted in diversifi ed geographical locations on about 4,000 households) of a longitudinal research project (entitled Microinsurance, Poverty and Vulnerability) of the Institute of Microfi nance (InM). The study fi nds that over 12-month period, only 40 per cent of the 6,352 sick individuals utilised formal health care. The poor and the children are the most deprived section in the utilisation. Out-of-pocket expenses per affected household during 12 months preceding the survey was BDT 4,686, which accounted for about 6 per cent of the total household expenditure. Drug, the single largest component of the OOP category, accounts for about 60 per cent of the direct OOP expenditure. The incidence of catastrophic expenditure was 15 per cent at the 10-per cent threshold level. In about 33 and 41 per cent of the cases, households needed to borrow or deplete assets for coping with inpatient care and catastrophic illnesses, respectively. Poor effective access to formal healthcare and high OOP expenditure indicate that Bangladesh has major challenges to overcome in achieving the universal health coverage. Membership in Grameen Kalyan micro health insurance scheme, essentially a discounted basic care package, has a significant association with the likelihood of using formal health care, though access to microcredit appear not to relieve households of the need to search for additional funds to cope with catastrophic events. An obvious suggestion is to introduce a risk-sharing mechanism (e.g., micro health insurance) to pool funds for the provision of health care in rural areas. Awareness building on the value of professional medical advice and measures targeted at effective regulation of the prices of essential drugs and restricting the sales of over-the-counter drugs are also put forward as elements of a sound public health policy framework.
References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- 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.
- Salem Deenadayalan Vaishnavi & Umakant Dash, 2009. "Catastrophic payments for health care among households in urban Tamil Nadu, India," Journal of International Development, John Wiley & Sons, Ltd., vol. 21(2), pages 169-184.
- Menno Pradhan & Nicholas Prescott, 2002. "Social risk management options for medical care in Indonesia," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 431-446.
- Falkingham, Jane, 2004. "Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan," Social Science & Medicine, Elsevier, vol. 58(2), pages 247-258, January.
- 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.
- Townsend, R.M., 1991.
"Risk and Insurance in Village India,"
University of Chicago - Economics Research Center
91-3, Chicago - Economics Research Center.
- Robert M. Townsend, . "Risk and Insurance in Village India," University of Chicago - Population Research Center 91-3a, Chicago - Population Research Center.
- Gabriela Flores & Jaya Krishnakumar & Owen O'Donnell & Eddy van Doorslaer, 2008. "Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1393-1412.
- Amin, Ruhul & St. Pierre, Maurice & Ahmed, Ashraf & Haq, Runa, 2001. "Integration of an Essential Services Package (ESP) in Child and Reproductive Health and Family Planning with a Micro-credit Program for Poor Women: Experience from a Pilot Project in Rural Bangladesh," World Development, Elsevier, vol. 29(9), pages 1611-1621, September.
- Ahmed, Syed Masud & Petzold, Max & Kabir, Zarina Nahar & Tomson, Göran, 2006. "Targeted intervention for the ultra poor in rural Bangladesh: Does it make any difference in their health-seeking behaviour?," Social Science & Medicine, Elsevier, vol. 63(11), pages 2899-2911, December.
- 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.
- Chunhuei Chi & Jwo-Leun Lee & Shu-Ling Tsai & Wen-Yi Chen, 2008. "Out-of-pocket payment for medical care under Taiwan's National Health Insurance system," Health Economics, John Wiley & Sons, Ltd., vol. 17(8), pages 961-975.
- Jennifer Roberts & Paul Mosley & Syed Abdul Hammid, 2010.
"Evaluating the Health Effects of Micro Health Insurance Placement: Evidence from Bangladesh,"
2010009, The University of Sheffield, Department of Economics, revised Apr 2010.
- Hamid, Syed Abdul & Roberts, Jennifer & Mosley, Paul, 2011. "Evaluating the Health Effects of Micro Health Insurance Placement: Evidence from Bangladesh," World Development, Elsevier, vol. 39(3), pages 399-411, March.
- Yardim, Mahmut Saadi & Cilingiroglu, Nesrin & Yardim, Nazan, 2010. "Catastrophic health expenditure and impoverishment in Turkey," Health Policy, Elsevier, vol. 94(1), pages 26-33, January.
- Hotchkiss, David Richards & Hutchinson, Paul Lawrence & Malaj, Altin & Berruti, Andres Alejandro, 2005. "Out-of-pocket payments and utilization of health care services in Albania: Evidence from three districts," Health Policy, Elsevier, vol. 75(1), pages 18-39, December.
- Ahmed, Syed Masud & Adams, Alayne M. & Chowdhury, Mushtaque & Bhuiya, Abbas, 2000. "Gender, socioeconomic development and health-seeking behaviour in Bangladesh," Social Science & Medicine, Elsevier, vol. 51(3), pages 361-371, August.
- Fosu, Gabriel B., 1994. "Childhood morbidity and health services utilization: Cross-national comparisons of user-related factors from DHS data," Social Science & Medicine, Elsevier, vol. 38(9), pages 1209-1220, May.
- Belli, Paolo & Gotsadze, George & Shahriari, Helen, 2004. "Out-of-pocket and informal payments in health sector: evidence from Georgia," Health Policy, Elsevier, vol. 70(1), pages 109-123, October.
When requesting a correction, please mention this item's handle: RePEc:imb:wpaper:13. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Jabeer Al Sherazy)
If references are entirely missing, you can add them using this form.