IDEAS home Printed from
   My bibliography  Save this paper

Disease-specific Impoverishment Impact of Out-of-Pocket Payments for Health Care: Evidence from Rural Bangladesh


  • Syed Abdul Hamid
  • Syed M. Ahsan


This paper examines disease-specific impoverishment impact of out-of-pocket (OOP) payments using a dataset of 3,941 households obtained from a survey conducted in 120 villages of seven districts in Bangladesh. We have estimated the poverty impact of OOP payments by comparing the difference between the average level of headcount poverty and poverty gap with and without health care payments. We find that OOP payments annually push 3.4 percent households into poverty in rural Bangladesh. The corresponding figures for those who had NCDs (non-communicable diseases), chronic illness, hospitalization and catastrophic illness respectively were 4.61, 4.65, 14.53 and 17.33 percent. Note that NCDs are the major part of the latter two situations (about 88% and 85% respectively). Looking into individual categories of NCDs we find that headcount impoverishment impact was immense for cholecystectomy, mental disorder, kidney disease, cancer and appendectomy. The impact on the intensity of impoverishment is the largest among the hospitalized patients and more individually among cancer patients. Hence, NCDs particularly chronic NCDs and those requiring immediate surgical procedures should be given more priority for policy framing. In addition to adopting some ex-ante measures (e.g. raising awareness regarding the risk factors causing NCDs), the paper argues for reforms to enhance efficiency in the public health care facilities and increasing quality of public health care.

Suggested Citation

  • Syed Abdul Hamid & Syed M. Ahsan, 2014. "Disease-specific Impoverishment Impact of Out-of-Pocket Payments for Health Care: Evidence from Rural Bangladesh," Working Papers 27, Institute of Microfinance (InM).
  • Handle: RePEc:imb:wpaper:27

    Download full text from publisher

    File URL:
    Download Restriction: no

    Other versions of this item:

    References listed on IDEAS

    1. 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.
    2. 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.
    3. 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, December.
    4. Syed Abdul Hamid & Syed M. Ahsan & Afroza Begum & Chowdhury Abdullah Al Asif, 2015. "Inequity in Formal Health Care Use: Evidence from Rural Bangladesh," Journal of International Development, John Wiley & Sons, Ltd., vol. 27(1), pages 36-54, January.
    5. 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.
    6. Ravallion, Martin & Sen, Binayak, 1996. "When Method Matters: Monitoring Poverty in Bangladesh," Economic Development and Cultural Change, University of Chicago Press, vol. 44(4), pages 761-792, July.
    7. Kochar, Anjini, 1995. "Explaining Household Vulnerability to Idiosyncratic Income Shocks," American Economic Review, American Economic Association, vol. 85(2), pages 159-164, May.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Hamid, Syed Abdul, 2014. "Designing an Health Insurance Scheme for Government Employees in Bangladesh: A Concept Paper," MPRA Paper 62841, University Library of Munich, Germany.
    2. Asankha Pallegedara, 2018. "Impacts of chronic non-communicable diseases on households’ out-of-pocket healthcare expenditures in Sri Lanka," International Journal of Health Economics and Management, Springer, vol. 18(3), pages 301-319, September.


    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:imb:wpaper:27. 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). General contact details of provider: .

    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 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.

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

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.