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Cost of illness for outpatients attending public and private hospitals in Bangladesh

Listed author(s):
  • Pavel, Md Sadik
  • Chakrabarty, Sayan
  • Gow, Jeff

Background A central aim of Universal Health Coverage (UHC) is protection for all against the cost of illness. In a low income country like Bangladesh the cost burden of health care in tertiary facilities is likely to be significant for most citizens. This cost of an episode of illness is a relatively unexplored policy issue in Bangladesh. The objective of this study was to estimate an outpatient’s total cost of illness as result of treatment in private and public hospitals in Sylhet, Bangladesh. Methods The study used face to face interviews at three hospitals (one public and two private) to elicit cost data from presenting outpatients. Other socio-economic and demographic data was also collected. A sample of 252 outpatients were randomly selected and interviewed. The total cost of outpatients comprises direct medical costs, non-medical costs and the indirect costs of patients and caregivers. Indirect costs comprise travel and waiting times and income losses associated with treatment. Results The costs of illness are significant for many of Bangladesh citizens. The direct costs are relatively minor compared to the large indirect cost burden that illness places on households. These indirect costs are mainly the result of time off work and foregone wages. Private hospital patients have higher average direct costs than public hospital patients. However, average indirect costs are higher for public hospital patients than private hospital patients by a factor of almost two. Total costs of outpatients are higher in public hospitals compared to private hospitals regardless of patient’s income, gender, age or illness. Conclusion Overall, public hospital patients, who tend to be the poorest, bear a larger economic burden of illness and treatment than relatively wealthier private hospital patients. The large economic impacts of illness need a public policy response which at a minimum should include a national health insurance scheme as a matter of urgency.

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Paper provided by University Library of Munich, Germany in its series MPRA Paper with number 74491.

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Date of creation: 13 Dec 2015
Date of revision: 03 Sep 2016
Publication status: Published in International Journal for Equity in Health 15.167(2016): pp. 1-12
Handle: RePEc:pra:mprapa:74491
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  1. McIntyre, Diane & Thiede, Michael & Dahlgren, Göran & Whitehead, Margaret, 2006. "What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?," Social Science & Medicine, Elsevier, vol. 62(4), pages 858-865, February.
  2. Balabanova, Dina & McKee, Martin, 2002. "Understanding informal payments for health care: the example of Bulgaria," Health Policy, Elsevier, vol. 62(3), pages 243-273, December.
  3. Koopmanschap, Marc A. & Rutten, Frans F. H. & van Ineveld, B. Martin & van Roijen, Leona, 1995. "The friction cost method for measuring indirect costs of disease," Journal of Health Economics, Elsevier, vol. 14(2), pages 171-189, June.
  4. Chima, Reginald Ikechukwu & Goodman, Catherine A. & Mills, Anne, 2003. "The economic impact of malaria in Africa: a critical review of the evidence," Health Policy, Elsevier, vol. 63(1), pages 17-36, January.
  5. Patrick Sakdapolrak & Thomas Seyler & Christina Ergler, 2013. "Burden of direct and indirect costs of illness: Empirical findings from slum settlements in Chennai, South India," Progress in Development Studies, , vol. 13(2), pages 135-151, April.
  6. Pavel, Md Sadik & Chakrabarty, Sayan & Gow, Jeff, 2014. "Assessing willingness to pay for health care quality improvements," MPRA Paper 68591, University Library of Munich, Germany.
  7. Sauerborn, R. & Adams, A. & Hien, M., 1996. "Household strategies to cope with the economic costs of illness," Social Science & Medicine, Elsevier, vol. 43(3), pages 291-301, August.
  8. Desmet, M. & Chowdhury, A. Q. & Islam, Md. K., 1999. "The potential for social mobilisation in Bangladesh: the organisation and functioning of two health insurance schemes," Social Science & Medicine, Elsevier, vol. 48(7), pages 925-938, April.
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