Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing

International Journal for Equity in Health

Research

Azaher Ali Molla¹  Chunhuei Chi² 

[1] Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh;Department of Applied Health Sciences, Public and Community Health, School of Nursing and Health Professions, Murray State University, Murray, KY, USA;School of Biological and Population Health Sciences, Milam 13, 97331-5109, Corvallis, OR, USA;Graduate Program in Health Management and Policy, College of Public Health and Human Sciences, Oregon State University, Milam 13, 97331-5109, Corvallis, OR, USA;Graduate Program in Applied Economics, Oregon State University, Milam 13, 97331-5109, Corvallis, OR, USA;Graduate Program in Public Policy, Oregon State University, Milam 13, 97331-5109, Corvallis, OR, USA;

关键词: Progressivity;    Ability-to-pay;    Household healthcare expenditure;    Health equity;    Out-of-pocket payments;   

DOI  :  10.1186/s12939-017-0654-3

 received in 2017-03-03, accepted in 2017-08-20,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe relationship between payments towards healthcare and ability to pay is a measure of financial fairness. Analysis of progressivity is important from an equity perspective as well as for macroeconomic and political analysis of healthcare systems. Bangladesh health systems financing is characterized by high out-of-pocket payments (63.3%), which is increasing. Hence, we aimed to see who pays what part of this high out-of-pocket expenditure. To our knowledge, this was the first progressivity analysis of health systems financing in Bangladesh.MethodsWe used data from Bangladesh Household Income and Expenditure Survey, 2010. This was a cross sectional and nationally representative sample of 12,240 households consisting of 55,580 individuals. For quantification of progressivity, we adopted the ‘ability-to-pay’ principle developed by O’Donnell, van Doorslaer, Wagstaff, and Lindelow (2008). We used the Kakwani index to measure the magnitude of progressivity.ResultsHealth systems financing in Bangladesh is regressive. Inequality increases due to healthcare payments. The differences between the Gini coefficient and the Kakwani index for all sources of finance are negative, which indicates regressivity, and that financing is more concentrated among the poor. Income inequality increases due to high out-of-pocket payments. The increase in income inequality caused by out-of-pocket payments is 89% due to negative vertical effect and 11% due to horizontal inequity.ConclusionsOur findings add substantial evidence of health systems financing impact on inequitable financial burden of healthcare and income. The heavy reliance on out-of-pocket payments may affect household living standards. If the government and people of Bangladesh are concerned about equitable financing burden, our study suggests that Bangladesh needs to reform the health systems financing scheme.

【 授权许可】

CC BY   
© The Author(s). 2017