Catastrophic Healthcare Expenditure and its Determinants in Bangladesh

Despite improvements in many health indicators throughout the last few decades globally, providing access to affordable healthcare remains a substantial challenge in many low- and middle-income countries including Bangladesh. Out-of-pocket (OOP) expenditure is one of the most noteworthy payment strategies for healthcare in Bangladesh and the share of OOP expenditure has been increasing alarmingly from 55.9% in 1997 to 74% in 2018 according to the WHO Global Health Expenditure dataset. Reliance on OOP payment results in two divergences, firstly, it leads to the catastrophic economic burden on households and secondly, inability to pay for adequate healthcare at the point of service by low-income people results in unmet need of health care. As a consequence, many households fall into poverty every year in Bangladesh. Further, this effect often leads low-income people to seek healthcare from untrained healthcare providers which in many cases results in adverse effects on health or inadequacy of required healthcare considering need. This study will assess the extent of Catastrophic Healthcare Expenditure (CHE) across various socio-economic strata of the population (e.g., urban vs. rural, poorest vs. richest, insurer vs. non-insurer etc.) and will able to find out the key drivers of CHE and impoverishment. The study will also try to identify the most vulnerable societies that are prone to financial hardship and therefore, the people with such characteristics should be brought under pre-payment schemes (e.g., insurance premium or tax-funded health safety-net). 

Objective of the Study: Within the current context of health system reforms, the aim of this study is to estimate the catastrophic healthcare expenditure and to assess the potential factors associated with CHE among Bangladeshi households.  The specific objectives of the study are;

1) To measure the extent of catastrophic health expenditure in Bangladesh.

2) To identify the determinants of catastrophic health expenditure in Bangladesh.

3) To explore way-out from catastrophic health expenditure and develop a policy matrix.

The study will offer a new policy recommendation for the reduction of the incidence of CHE in Bangladesh with implications for other developing countries.

Principal Investigator/Study Director:  Dr. Abdur Razzaque Sarker

Division: Population Studies Division (PSD)

Funding Agency:  Health Economics Unit, Ministry of Health and Family Welfare, Bangladesh

Duration March 2021 to August 2021