Khan Jinat Jahan, Sehrin Farzana, Quayyum Zahidul, Sarker Abdur Razzaque, Rahman Mohammad Shafiqur
Centre of Excellence for Urban Equity and Health (CUEH), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh.
PLoS One. 2025 Apr 9;20(4):e0320429. doi: 10.1371/journal.pone.0320429. eCollection 2025.
In the absence of universal healthcare protection, out-of-pocket (OOP) expenditures are the main source of healthcare financing in Bangladesh. This study assesses the disparities in the overall and the components of OOP expenditures among households with both chronic and acute illnesses compared to those having acute illnesses only. It also identifies factors influencing OOP expenditures over time and examines patterns related to various illness conditions.
Data from the Household Income and Expenditure Surveys (HIES) of 2016-17 and 2022 were used. A Log-linear Multiple Regression Model was employed to identify factors influencing OOP expenditures in households with different disease profiles.
The average OOP expenditures increased significantly from 2016 to 2022, even after inflation adjustments. Higher expenditures were observed in urban households BDT 939.34 in 2016 and BDT 1605.36 in 2022, and in households having both chronic and acute illness conditions with OOP expenditure of BDT 2290.43 and BDT 3525.32 in 2016 and 2022 respectively. Wealthier households spent more on healthcare, with the cost of medicines being the largest component with over 50% of total OOP expenditures. The regression analysis suggests that area of residence (urban vs rural), household size, level of education of the household head, the presence of elderly members (≥60 years), the number of employed members and sick household members, and hospitalisation of household members were mainly responsible for higher OOP expenditure.
Our study provides valuable insights on the determinants of OOP expenditures over time, with a notable increase among households managing both chronic and acute illnesses, and in urban areas. Key contributors to increased expenditures include medicines, medical tests and surgery costs, with cancer causing higher expenses. This study recommends improving treatment protocols help reduce unnecessary prescriptions of medicine and investigations, and alleviate financial burdens of the vulnerable population.
在缺乏全民医疗保健保护的情况下，自付费用是孟加拉国医疗保健融资的主要来源。本研究评估了患有慢性和急性疾病的家庭与仅患有急性疾病的家庭在自付费用总额及其组成部分方面的差异。它还确定了随时间影响自付费用的因素，并研究了与各种疾病状况相关的模式。
使用了2016 - 17年和2022年家庭收入与支出调查（HIES）的数据。采用对数线性多元回归模型来确定影响不同疾病状况家庭自付费用的因素。
即使经过通胀调整，2016年至2022年期间平均自付费用仍显著增加。城市家庭的支出较高，2016年为939.34塔卡，2022年为1605.36塔卡；患有慢性和急性疾病的家庭，2016年和2022年的自付费用分别为2290.43塔卡和3525.32塔卡。较富裕的家庭在医疗保健上花费更多，药品成本是最大的组成部分，占自付费用总额的50%以上。回归分析表明，居住地区（城市与农村）、家庭规模、户主受教育程度、老年成员（≥60岁）的存在、就业成员和患病家庭成员的数量以及家庭成员的住院情况是自付费用较高的主要原因。
我们的研究提供了关于随时间推移自付费用决定因素的宝贵见解，在同时管理慢性和急性疾病的家庭以及城市地区，自付费用显著增加。支出增加的主要因素包括药品、医学检查和手术费用，癌症导致的费用更高。本研究建议改进治疗方案，有助于减少不必要的药品处方和检查，减轻弱势群体的经济负担。
