Medication major share of healthcare expenses in Bangladesh

Muhammad Zahir Hassan Nabil

Cost of medicine is the largest share of money spent for healthcare by people belonging to all walks of life in Bangladesh, indicates an icddr,b study.

[Click to enlarge] Share of OOP expenses. Infographic: icddr,b. Photo: Sumon Yusuf / icddr,b

“Much needs to be done to ensure financial security for people belonging to lower socio-economic status who cannot afford these expenses,” says Dr Mahbub Elahi Chowdhury, icddr,b scientist and acting head of universal health coverage (UHC) programme at icddr,b.

Financial protection is one of the key targets for achieving UHC, which also seeks to improve the quality and readiness of health services. In a nutshell, UHC means that everyone can access quality health services without financial hardship, according to the World Health Organization (WHO).

However, individuals belonging to lower socio-economic groups in Bangladesh are spending up to 16 percent of their monthly household income for healthcare, notes the aforementioned study published in Journal of Preventive Medicine and Public Health.

Around 61 percent of total healthcare expenses paid out of pocket (OOP) goes into purchasing medicines, says Mr Rashidul Alam Mahumud, senior research officer at icddr,b, who authored the study.

For many, healthcare expense is a major share of their income. Photo: Shumon Ahmed / icddr,b

Payments for physicians, conveyance and diagnostic tests are the other major areas of OOP expenditures, informs Mr Abdur Razzaque Sarker, co-author of the study and assistant scientist at icddr,b.

Recent findings from the Global Burden of Disease (GBD) health financing network have ranked Bangladesh as the sixth largest country (tied with India) where people spend most from their own pockets for healthcare. Of total healthcare spending, over 65 percent of money has been spent out of pockets according the recent study published in The Lancet that analysed health spending data from 2014.


How UHC can help

"People often unnecessarily buy restricted medicines without prescriptions," says Dr Chowdhury. He feels that this problem can be mitigated through promotion of UHC by reducing OOP cost for purchasing drugs.

OOP expenses for healthcare are particularly high for people suffering from chronic illness and associated disabilities, found another icddr,b study looking into household income and expenditure pattern at national level.

“People who can afford, spend more as the findings have shown. But those unable, spend less or nothing at all out of their pockets which is essentially a ‘no-pocket issue’ that UHC can minimise,” says Dr Marufa Sultana, assistant scientist at icddr,b and principal author of a study on the burden of chronic illness, published in Chronic Diseases and Translational Medicine.

Rural and elderly populations are in greater need of healthcare financing. Photo: GMB Akash / icddr,b

These findings send a clear message to the government to strengthen health systems by focusing on rural and elderly populations and those belonging to lower socioeconomic strata.

Earlier studies by icddr,b researchers have already shown that that people who are most in need of healthcare are deprived of standard care, demonstrating a persistent inequity in healthcare utilisation.


Way forward: Facilitating UHC in resource-poor setting

A recent icddr,b study examined whether a pilot micro-health insurance scheme works for the poorest communities in rural setting. The findings published in Global Health Action indicated that around 20 percent people were motivated to enrol in these schemes, of which around 40 percent renewed their memberships to avail health benefit cover.

This means that some of those in the lower socio-economic strata are willing to participate in medical insurance.

In resource-limited settings, local cooperatives based on common interests pool community money to help households. Mr Sarker and colleagueshave proposed in a BMJ Global Health paper that such cooperative societies might be one of the platforms towards promoting UHC.

This is because a vast number of people in Bangladesh have their membership with around 200,000 of such societies. Health financing through these cooperatives might cover the OOP payments for its members and thereby ensure financial protection.

These recent icddr,b study findings can help the government take important policy decisions as the country moves forward to achieve UHC according to its 20-year health financing strategy, which has been prepared by the Government of Bangladesh in consultation with icddr,b and other stakeholders.