Pavel Md Sadik, Chakrabarty Sayan, Gow Jeff
Department of Economics, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh.
Institute for Resilient Regions (IRR), University of Southern Queensland, Springfield, 4300, QLD, Australia.
Int J Equity Health. 2016 Oct 10;15(1):167. doi: 10.1186/s12939-016-0458-x.
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.
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.
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.
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.
全民健康覆盖（UHC）的一个核心目标是保护所有人免受疾病费用的影响。在孟加拉国这样的低收入国家，三级医疗机构的医疗费用负担对大多数公民来说可能是巨大的。在孟加拉国，疾病发作的这种费用是一个相对未被探讨的政策问题。本研究的目的是估计孟加拉国锡尔赫特私立和公立医院门诊患者因治疗而产生的疾病总成本。
该研究在三家医院（一家公立医院和两家私立医院）进行面对面访谈，以获取前来就诊的门诊患者的费用数据。还收集了其他社会经济和人口数据。随机抽取252名门诊患者进行访谈。门诊患者的总成本包括直接医疗费用、非医疗费用以及患者和护理人员的间接费用。间接费用包括交通和等待时间以及与治疗相关的收入损失。
疾病费用对许多孟加拉国公民来说是巨大的。与疾病给家庭带来的巨大间接成本负担相比，直接成本相对较小。这些间接成本主要是误工和工资损失的结果。私立医院患者的平均直接成本高于公立医院患者。然而，公立医院患者的平均间接成本比私立医院患者高出近两倍。无论患者的收入、性别、年龄或疾病如何，公立医院门诊患者的总成本都高于私立医院。
总体而言，往往是最贫困的公立医院患者比相对富裕的私立医院患者承担更大的疾病和治疗经济负担。疾病带来的巨大经济影响需要公共政策做出回应，至少应包括紧急推行国家健康保险计划。
