Rahman Md Mizanur, Islam Md Rashedul, Rahman Md Shafiur, Hossain Fahima, Alam Ashraful, Rahman Md Obaidur, Jung Jenny, Akter Shamima
Hitotsubashi Institute for Advanced Study, Hitotsubashi University, 2-1 Naka Kunitachi, Tokyo, 186-8601, Japan.
Department of Global Health Policy, School of International Health, The University of Tokyo, Tokyo, Japan.
Health Econ Rev. 2022 Jan 10;12(1):5. doi: 10.1186/s13561-021-00348-6.
Ensuring access to health services for all is the main goal of universal health coverage (UHC) plan. Out-of-pocket (OOP) payment still remains the main source of funding for healthcare in Bangladesh. The association between barriers to accessing healthcare and over-reliance on OOP payments has not been explored in Bangladesh using nationally representative household survey data. This study is a novel attempt to examine the burden of OOP payment and forgone healthcare in Bangladesh, and further explores the inequalities in catastrophic health expenditures (CHE) and forgone healthcare at the national and sub-national levels.
This study used data from the most recent nationally representative cross-sectional survey, Bangladesh Household Income and Expenditure Survey, conducted in 2016-17 (N = 39,124). In order to identify potential determinants of CHE and forgone healthcare, multilevel Poisson regression was used. Inequalities in CHE and forgone healthcare were measured using the slope index of inequality.
Around 25% of individuals incurred CHE and 14% of the population had forgone healthcare for any reasons. The most common reasons for forgone healthcare were treatment cost (17%), followed by none to accompany or need for permission (5%), and distance to health facility (3%). Multilevel analysis indicated that financial burden and forgone care was higher among households with older populations or chronic illness, and those who utilize either public or private health facilities. Household consumption quintile had a linear negative association with forgone care and positive association with CHE.
This study calls for incorporation of social safety net in health financing system, increase health facility, and gives priority to the disadvantaged population to ensure access to health services for all.
确保所有人都能获得医疗服务是全民健康覆盖（UHC）计划的主要目标。自付费用仍然是孟加拉国医疗保健资金的主要来源。孟加拉国尚未利用具有全国代表性的家庭调查数据来探讨获得医疗保健的障碍与过度依赖自付费用之间的关联。本研究是一项新颖的尝试，旨在研究孟加拉国自付费用和医疗服务未获提供的负担，并进一步探讨国家和次国家层面灾难性卫生支出（CHE）和医疗服务未获提供方面的不平等情况。
本研究使用了2016 - 17年进行的最新全国代表性横断面调查——孟加拉国家庭收入与支出调查的数据（N = 39124）。为了确定CHE和医疗服务未获提供的潜在决定因素，采用了多水平泊松回归分析。使用不平等斜率指数来衡量CHE和医疗服务未获提供方面的不平等情况。
约25%的个体发生了CHE，14%的人口因任何原因未获得医疗服务。未获得医疗服务的最常见原因是治疗费用（17%），其次是无人陪同或需要许可（5%）以及距离医疗机构较远（3%）。多水平分析表明，在老年人口或患有慢性病的家庭以及使用公共或私立医疗机构的家庭中，经济负担和未获得的医疗服务更高。家庭消费五分位数与未获得的医疗服务呈线性负相关，与CHE呈正相关。
本研究呼吁在卫生筹资系统中纳入社会安全网，增加医疗机构，并优先关注弱势群体，以确保所有人都能获得医疗服务。
