Tahsina Tazeen, Ali Nazia Binte, Hoque D M Emdadul, Huda Tanvir M, Salam Shumona Sharmin, Hasan Mohammad Mehedi, Hossain Md Altaf, Matin Ziaul, Kuppen Lianne, Garnett Sarah P, Arifeen Shams El
Maternal and Child Health Division (MCHD), icddr,b, Dhaka, Bangladesh.
IMCI, Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MOHFW), Dhaka, Bangladesh.
J Health Popul Nutr. 2017 Sep 11;36(1):33. doi: 10.1186/s41043-017-0110-4.
Bangladesh has committed to universal health coverage, and options to decrease household out-of-pocket expenditure (OPE) are being explored. Understanding the determinants of OPE is an essential step. This study aimed to estimate and identify determinants of OPE in seeking health care for sick under-five children.
Cross-sectional data was collected by structured questionnaire in 2009 (n = 7362) and 2012 (n = 6896) from mothers of the under-five children. OPE included consultation fees and costs of medicine, diagnostic tests, hospital admission, transport, accommodation, and food. Expenditure is expressed in US dollars and adjusted for inflation. Linear regression was used for ascertaining the determinants of OPE.
Between 2009 and 2012, the median OPE for seeking care for a sick under-five child increased by ~ 50%, from USD 0.82 (interquartile range 0.39-1.49) to USD 1.22 (0.63-2.36) per child/visit. Increases were observed in every component OPE measured, except for consultation fees which decreased by 12%. Medicine contributed the major portion of overall OPE. Higher overall OPE for care seeking was associated with a priority illness (20% increase), care from trained providers (90% public/~ 2-fold private), residing in hilly/wet lands areas (20%), and for mothers with a secondary education (19%).
OPE is a major barrier to quality health care services and access to appropriate medicine is increasing in rural Bangladesh. To support the goal of universal health care coverage, geographic imbalances as well as expanded health financing options need to be explored.
孟加拉国已致力于实现全民健康覆盖，并正在探索降低家庭自付费用（OPE）的方法。了解OPE的决定因素是至关重要的一步。本研究旨在估计并确定五岁以下患病儿童寻求医疗服务时OPE的决定因素。
通过结构化问卷于2009年（n = 7362）和2012年（n = 6896）收集五岁以下儿童母亲的横断面数据。OPE包括诊疗费以及药品、诊断检查、住院、交通、住宿和食品费用。支出以美元表示并根据通货膨胀进行调整。采用线性回归确定OPE的决定因素。
2009年至2012年期间，五岁以下患病儿童每次就诊寻求医疗服务的OPE中位数增加了约50%，从每名儿童每次就诊0.82美元（四分位间距0.39 - 1.49美元）增至1.22美元（0.63 - 2.36美元）。除诊疗费下降了12%外，所测量的OPE的每个组成部分均有增加。药品占总体OPE的主要部分。寻求医疗服务时较高的总体OPE与优先疾病（增加20%）、接受受过培训的医疗服务提供者的治疗（公立约90%/私立约2倍）、居住在山区/湿地地区（20%）以及母亲接受过中等教育（19%）有关。
OPE是获得优质医疗服务的主要障碍，在孟加拉国农村地区，获得适当药品的费用正在增加。为支持全民医疗覆盖目标，需要探索地理上的不平衡以及扩大医疗融资选择。
