Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis
Abstract Background Ensuring access to health services for all is the main goal of universal health coverage (UHC) plan. Out-of-pocket (OOP) payment still remains the main source of funding for healthcare in Bangladesh. The association between barriers to accessing healthcare and over-reliance on OO...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | Health Economics Review |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13561-021-00348-6 |
| _version_ | 1818752902953435136 |
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| author | Md. Mizanur Rahman Md. Rashedul Islam Md. Shafiur Rahman Fahima Hossain Ashraful Alam Md. Obaidur Rahman Jenny Jung Shamima Akter |
| author_facet | Md. Mizanur Rahman Md. Rashedul Islam Md. Shafiur Rahman Fahima Hossain Ashraful Alam Md. Obaidur Rahman Jenny Jung Shamima Akter |
| author_sort | Md. Mizanur Rahman |
| collection | DOAJ |
| description | Abstract Background Ensuring access to health services for all is the main goal of universal health coverage (UHC) plan. Out-of-pocket (OOP) payment still remains the main source of funding for healthcare in Bangladesh. The association between barriers to accessing healthcare and over-reliance on OOP payments has not been explored in Bangladesh using nationally representative household survey data. This study is a novel attempt to examine the burden of OOP payment and forgone healthcare in Bangladesh, and further explores the inequalities in catastrophic health expenditures (CHE) and forgone healthcare at the national and sub-national levels. Methods This study used data from the most recent nationally representative cross-sectional survey, Bangladesh Household Income and Expenditure Survey, conducted in 2016–17 (N = 39,124). In order to identify potential determinants of CHE and forgone healthcare, multilevel Poisson regression was used. Inequalities in CHE and forgone healthcare were measured using the slope index of inequality. Results Around 25% of individuals incurred CHE and 14% of the population had forgone healthcare for any reasons. The most common reasons for forgone healthcare were treatment cost (17%), followed by none to accompany or need for permission (5%), and distance to health facility (3%). Multilevel analysis indicated that financial burden and forgone care was higher among households with older populations or chronic illness, and those who utilize either public or private health facilities. Household consumption quintile had a linear negative association with forgone care and positive association with CHE. Conclusion This study calls for incorporation of social safety net in health financing system, increase health facility, and gives priority to the disadvantaged population to ensure access to health services for all. |
| first_indexed | 2024-12-18T04:58:51Z |
| format | Article |
| id | doaj.art-7105a686f85a4fbf9a9b6712f3fafc12 |
| institution | Directory Open Access Journal |
| issn | 2191-1991 |
| language | English |
| last_indexed | 2024-12-18T04:58:51Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Health Economics Review |
| spelling | doaj.art-7105a686f85a4fbf9a9b6712f3fafc122022-12-21T21:20:12ZengBMCHealth Economics Review2191-19912022-01-0112111110.1186/s13561-021-00348-6Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysisMd. Mizanur Rahman0Md. Rashedul Islam1Md. Shafiur Rahman2Fahima Hossain3Ashraful Alam4Md. Obaidur Rahman5Jenny Jung6Shamima Akter7Hitotsubashi Institute for Advanced Study, Hitotsubashi UniversityDepartment of Global Health Policy, School of International Health, The University of TokyoResearch Centre for Child Mental Development, Hamamatsu University School of MedicineGlobal Public Health Research FoundationDepartment of Global Health Policy, School of International Health, The University of TokyoDepartment of Global Health Nursing, Graduate School of Nursing Science, St. Luke’s International UniversityGlobal Public Health Research FoundationHitotsubashi Institute for Advanced Study, Hitotsubashi UniversityAbstract Background Ensuring access to health services for all is the main goal of universal health coverage (UHC) plan. Out-of-pocket (OOP) payment still remains the main source of funding for healthcare in Bangladesh. The association between barriers to accessing healthcare and over-reliance on OOP payments has not been explored in Bangladesh using nationally representative household survey data. This study is a novel attempt to examine the burden of OOP payment and forgone healthcare in Bangladesh, and further explores the inequalities in catastrophic health expenditures (CHE) and forgone healthcare at the national and sub-national levels. Methods This study used data from the most recent nationally representative cross-sectional survey, Bangladesh Household Income and Expenditure Survey, conducted in 2016–17 (N = 39,124). In order to identify potential determinants of CHE and forgone healthcare, multilevel Poisson regression was used. Inequalities in CHE and forgone healthcare were measured using the slope index of inequality. Results Around 25% of individuals incurred CHE and 14% of the population had forgone healthcare for any reasons. The most common reasons for forgone healthcare were treatment cost (17%), followed by none to accompany or need for permission (5%), and distance to health facility (3%). Multilevel analysis indicated that financial burden and forgone care was higher among households with older populations or chronic illness, and those who utilize either public or private health facilities. Household consumption quintile had a linear negative association with forgone care and positive association with CHE. Conclusion This study calls for incorporation of social safety net in health financing system, increase health facility, and gives priority to the disadvantaged population to ensure access to health services for all.https://doi.org/10.1186/s13561-021-00348-6Out-of-pocket health paymentCatastrophic health expenditureForgone healthcareMultilevel analysisBangladesh |
| spellingShingle | Md. Mizanur Rahman Md. Rashedul Islam Md. Shafiur Rahman Fahima Hossain Ashraful Alam Md. Obaidur Rahman Jenny Jung Shamima Akter Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis Health Economics Review Out-of-pocket health payment Catastrophic health expenditure Forgone healthcare Multilevel analysis Bangladesh |
| title | Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis |
| title_full | Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis |
| title_fullStr | Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis |
| title_full_unstemmed | Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis |
| title_short | Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis |
| title_sort | forgone healthcare and financial burden due to out of pocket payments in bangladesh a multilevel analysis |
| topic | Out-of-pocket health payment Catastrophic health expenditure Forgone healthcare Multilevel analysis Bangladesh |
| url | https://doi.org/10.1186/s13561-021-00348-6 |
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