Department of Economics, American International University, Dhaka, Bangladesh.
School of Commerce, University of Southern Queensland, Toowoomba, QLD, Australia.
Appl Health Econ Health Policy. 2018 Apr;16(2):219-234. doi: 10.1007/s40258-018-0376-8.
The Government of Bangladesh has a National Healthcare Strategy 2012-2032 that reiterates a goal to achieve universal health coverage (UHC) by the year 2032. To achieve the goal, the government has set up a strategy to reduce the share of out-of-pocket (OOP) expenditure from the current 64% of the total household healthcare costs to 32% at the national level. As the majority of the people live in the rural areas, and the rural people are generally poor, the success of the strategy relies predominantly on any type of pro-poor healthcare policy and strategy.
To estimate if there is any feedback effect in the healthcare costs model and to estimate relative contributions of various determinants to OOP medical expenditure in rural Bangladesh.
This study used an econometric approach and a system of simultaneous equations models. The OOP expenditure was measured by household medical expenditure, which is a sum of expenditures for medicine, ayurvedic, various kinds of tests, hospitalization, and dental-related, incidental and other health-related costs. The feedback effect hypothesis is tested by the level of statistically significant dependent variables of the three equations used in the system of simultaneous equations model. The relative importance of the determinants of OOP expenditures was measured by the size of standardised coefficients of the determinants.
There is a feedback effect between the three dependent variables-medical expenditure, sickness of the household members and the selection of healthcare provider. We also find that although the selection of private healthcare facilities is relatively the most important determinant of OOP expenditures in the rural areas, the sickness of the members of a household and the selection of healthcare provider together have a real effect on the OOP expenditure in rural Bangladesh.
Bangladesh needs a holistic approach to undertake any strategy; private healthcare facilities are relatively the most important source of high medicine costs; hence, the supply of medicine and its price should be given attention on a priority basis for pro-poor policy framing in conjunction with healthcare insurance and motivation to consult doctors rather than pharmacists in case of sickness.
孟加拉国政府制定了《2012-2032 年国家医疗保健战略》，重申了到 2032 年实现全民健康覆盖的目标。为了实现这一目标，政府制定了一项战略，将目前占家庭医疗总支出 64%的自付（OOP）支出份额降低到全国 32%。由于大多数人居住在农村地区，而农村地区的人普遍贫困，因此该战略的成功主要依赖于任何形式的扶贫医疗政策和战略。
估计医疗成本模型中是否存在反馈效应，并估计各种决定因素对孟加拉国农村地区 OOP 医疗支出的相对贡献。
本研究使用计量经济学方法和联立方程组模型。OOP 支出通过家庭医疗支出来衡量，家庭医疗支出是指药品、阿育吠陀、各种检查、住院、牙科相关、偶然和其他与健康相关的费用的总和。通过联立方程组模型中使用的三个方程的统计上显著的因变量的水平来检验反馈效应假设。通过决定因素的标准化系数的大小来衡量 OOP 支出决定因素的相对重要性。
在三个因变量（医疗支出、家庭成员的疾病和医疗服务提供者的选择）之间存在反馈效应。我们还发现，尽管选择私人医疗设施是农村地区 OOP 支出的最重要决定因素，但家庭成员的疾病和医疗服务提供者的选择共同对孟加拉国农村地区的 OOP 支出有实际影响。
孟加拉国需要采取整体方法来实施任何战略；私人医疗设施是高药费的相对最重要来源；因此，应优先考虑药品的供应及其价格，同时结合医疗保险和激励措施，鼓励在生病时咨询医生而不是药剂师。
