Hossain Altaf, Alam Md Jahangir, Mydam Janardhan, Tareque Mohammad
Department of Statistics, Islamic University, Kushtia, 7003, Bangladesh.
Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
BMC Public Health. 2022 Feb 10;22(1):270. doi: 10.1186/s12889-022-12656-5.
Chronic illness with disability and its out-of-pocket expenditure (OOPE) remains a big financial challenge in Bangladesh. The purpose of this study was to explore how religious minority problem and coastal climate crisis with other common risk factors determined chronic illness with a disability and its financial burden in Bangladesh. Existing policy responses, especially, social safety net programs and their governance were analyzed for suggesting better policy options that avoid distress financing.
Binary logistic and multiple linear regression models were respectively used to identify the factors of disability, and high OOPE based on Bangladesh Household Income and Expenditure Survey 2016 data.
We found that disable people had relatively higher OOPE than their non-disabled counterparts and this OOPE further surges when the number of disabilities increases. In addition to the common factors, the novelty of our findings indicated that the religious minority problem as well as the coastal climate crisis have bearing on the disability burden in Bangladesh. The likelihood of having a chronic illness with a disability was 13.2% higher for the religious minorities compared to the majorities (Odds ratio (OR): 1.132, 95% confidence interval (CI): 1.033-1.241) and it was 21.6% higher for the people who lived in the exposed coast than those who lived in the non-exposed area (OR: 1.216, 95% CI: 1.107-1.335). With disabilities, people from the exposed coast incurred higher OOPE than those from the non-exposed areas. Although receiving assistance from social safety net programs (SSNPs) seemed to reduce their high OOPE and financial distress such as selling assets and being indebted, the distribution was not equitably and efficiently managed to confirm the process of inclusion leakage-free. On average, those who enrolled from the minority group and the exposed coast paid the relatively higher bribes.
To reduce burden, the government should strengthen and specify the existing SSNPs more for disable people, especially from the minority group and the exposed coast, and ensure the selection process more inclusive and leakage-free.
慢性病及其残疾问题以及自付费用在孟加拉国仍然是一个巨大的财政挑战。本研究的目的是探讨宗教少数群体问题、沿海气候危机以及其他常见风险因素如何决定孟加拉国的慢性病及其残疾问题和财政负担。对现有的政策应对措施，特别是社会安全网计划及其治理进行了分析，以提出避免困境融资的更好政策选择。
分别使用二元逻辑回归模型和多元线性回归模型，基于2016年孟加拉国家庭收入与支出调查数据，确定残疾因素和高额自付费用因素。
我们发现，残疾人的自付费用相对高于非残疾人，而且随着残疾人数的增加，这种自付费用会进一步激增。除了常见因素外，我们研究结果的新颖之处在于，宗教少数群体问题以及沿海气候危机对孟加拉国的残疾负担有影响。宗教少数群体患慢性病并伴有残疾的可能性比多数群体高13.2%（优势比（OR）：1.132，95%置信区间（CI）：1.033 - 1.241），居住在受影响海岸地区的人比居住在未受影响地区的人高21.6%（OR：1.216，95%CI：1.107 - 1.335）。有残疾的情况下，来自受影响海岸地区的人比未受影响地区的人产生更高的自付费用。虽然从社会安全网计划（SSNP）获得援助似乎减少了他们高额的自付费用和诸如出售资产及负债等财政困境，但分配并未得到公平有效的管理，无法确保无遗漏的纳入过程。平均而言，来自少数群体和受影响海岸地区的参保者支付的贿赂相对较高。
为减轻负担，政府应加强并更明确地为残疾人，特别是来自少数群体和受影响海岸地区的残疾人制定现有的社会安全网计划，并确保选择过程更具包容性且无遗漏。
