Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, UK.
Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Popul Health Metr. 2023 Sep 5;21(1):12. doi: 10.1186/s12963-023-00312-y.
The distribution of healthcare services should be based on the needs of the population, regardless of their ability to pay. Achieving universal health coverage implies first ensuring that people of all income levels have access to quality healthcare, and then allocating resources reasonably considering individual need. Hence, this study aims to understand how public benefits in Bangladesh are currently distributed among wealth quintiles considering different layers of healthcare facilities and to assess the distributional impact of public benefits.
To conduct this study, data were extracted from the recent Bangladesh Demographic and Health Survey 2017-18. We performed benefit incidence analysis to determine the distribution of maternal and child healthcare utilization in relation to wealth quintiles. Disaggregated and national-level public benefit incidence analysis was conducted by the types of healthcare services, levels of healthcare facilities, and overall utilization. Concentration curves and concentration indices were estimated to measure the equity in benefits distribution.
An unequal utilization of public benefits observed among the wealth quintiles for maternal and child healthcare services across the different levels of healthcare facilities in Bangladesh. Overall, upper two quintiles (richest 19.8% and richer 21.7%) utilized more benefits from public facilities compared to the lower two quintiles (poorest 18.9% and poorer 20.1%). Benefits utilization from secondary level of health facilities was highly pro-rich, while benefit utilization found pro-poor at primary levels. The public benefits in Bangladesh were also not distributed according to the needs of the population; nevertheless, poorest 20% household cannot access 20% share of public benefits in most of the maternal and child healthcare services even if we ignore their needs.
Benefit incidence analysis in public health spending demonstrates the efficacy with which the government allocates constrained health resources to satisfy the needs of the poor. Public health spending in Bangladesh on maternal and child healthcare services were not equally distributed among wealth quintiles. Overall health benefits were more utilized by the rich relative to the poor. Hence, policymakers should prioritize redistribution of resources by targeting the socioeconomically vulnerable segments of the population to increase their access to health services to meet their health needs.
医疗服务的分配应基于人口需求，而不论其支付能力如何。实现全民健康覆盖意味着首先要确保所有收入水平的人都能获得高质量的医疗保健，然后再根据个人需求合理分配资源。因此，本研究旨在了解孟加拉国目前在考虑不同层次的医疗保健设施的情况下，如何在财富五分位数之间分配公共福利，并评估公共福利的分配影响。
为了进行这项研究，数据取自最近的 2017-18 年孟加拉国人口与健康调查。我们进行了受益情况分析，以确定与财富五分位数相关的母婴保健利用情况的分布。通过医疗服务类型、医疗设施水平和总体利用情况对国家层面的受益情况进行了分类和分析。使用集中曲线和集中指数来衡量受益分配的公平性。
在孟加拉国，不同层次的医疗设施中，母婴保健服务的公共福利利用在财富五分位数之间存在不平等。总体而言，上两个五分位数（最富有 19.8%和更富有 21.7%）比下两个五分位数（最贫穷 18.9%和更贫穷 20.1%）从公共设施中获得更多的福利。二级医疗设施的福利利用是高度偏向富人的，而初级医疗设施的福利利用则偏向穷人。孟加拉国的公共福利也没有按照人口的需求来分配；尽管如此，在大多数母婴保健服务中，最贫穷的 20%家庭甚至忽略了他们的需求，也无法获得 20%的公共福利份额。
公共卫生支出的受益情况分析表明，政府在将有限的卫生资源分配给穷人以满足其需求方面的效率。孟加拉国在母婴保健服务方面的公共卫生支出在财富五分位数之间分配不均。总体而言，与穷人相比，富人更能利用整体健康福利。因此，政策制定者应该通过针对社会经济弱势群体重新分配资源，优先考虑增加他们获得卫生服务的机会，以满足他们的健康需求。
