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Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis

Md. Mizanur Rahman (), Md. Rashedul Islam, Md. Shafiur Rahman, Fahima Hossain, Ashraful Alam, Md. Obaidur Rahman, Jenny Jung and Shamima Akter
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Md. Mizanur Rahman: Hitotsubashi Institute for Advanced Study, Hitotsubashi University
Md. Rashedul Islam: The University of Tokyo
Md. Shafiur Rahman: Hamamatsu University School of Medicine
Fahima Hossain: Global Public Health Research Foundation
Ashraful Alam: The University of Tokyo
Md. Obaidur Rahman: St. Luke’s International University
Jenny Jung: Global Public Health Research Foundation
Shamima Akter: Hitotsubashi Institute for Advanced Study, Hitotsubashi University

Health Economics Review, 2022, vol. 12, issue 1, 1-11

Abstract: 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.

Keywords: Out-of-pocket health payment; Catastrophic health expenditure; Forgone healthcare; Multilevel analysis; Bangladesh (search for similar items in EconPapers)
Date: 2022
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DOI: 10.1186/s13561-021-00348-6

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