Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?

Abstract

Introduction Out-of-pocket (OOP) payments for healthcare severely affect the current consumption, future health and earnings capacity of poor/underprivileged households and hence it is crucial for priority setting. This study assesses the variation in overall as well as disease-specific impoverishment impact of OOP payments between the regions experiencing different climate change risks, defined as high disaster-prone (HDP) areas and low-disaster-prone (LDP) areas, in Bangladesh. Materials and methods This paper estimated three poverty measures, such as poverty headcount, poverty intensity and normalized poverty gap for all ailments, catastrophic events, diseases types (communicable, non-communicable (NCDs), and accident and injury), illness conditions (acute and chronic) and hospitalization using 3,791 randomly selected rural households (1,203 from HDP and 2,588 from LDP areas) across the regions. Cost of basic need approach was used for estimating poverty line expenditure. Results About 13 percent households annually fall into poverty due to OOP outlays for healthcare. Despite having significantly (p-value≤0.01) less OOP payments (HDP areas: BDT 5,117; LDP areas: BDT5,811) the impoverishment impact of OOP payments for healthcare in HDP areas (16.5%) has substantially higher than LDP areas (11.3%). Population in HDP areas, especially char (river island; 19.55 percent) and haor (water submerged; 16.80 percent) are more susceptible to any level of OOP payments due to low level of earnings. Catastrophic healthcare expenditure (61.79%) and NCDs (14.29 percent) are exacerbating the poverty level in Bangladesh. Both absolute and relative average poverty gap are more widen in HDP than LDP areas due to catastrophic OOP outlays for healthcare. Conclusion The impoverishment effect due to OOP payments for healthcare in both HDP and LDP areas are high, especially for NCDs and catastrophic healthcare expenditure. However, the situation is bit worse in HDP areas. Preventing the escalation of NCDs as well as catastrophic expenditure and hence reducing the level of impoverishment thereof call for restricting tobacco use, increasing physical activity, encouraging to intake healthy diets, ensuring food safety, controlling air pollution, and improving mental health. Moreover, government should give more emphasis, especially in the HDP areas, on making community clinics more functional through providing screening equipment and training to the Community Health Care Providers for early detection of NCDs, and ensuring availability of medicine all the time. Note that other than community clinics, there is little option for providing healthcare in HDP areas due to poor functionality of public facilities as well as lack of private facilities in HDP areas.

From the local disparities to national realities: Mapping and multilevel modeling of catastrophic health expenditure in Bangladesh using HIES 2016

“…The high frequency of chronic diseases in those districts, coupled with their economic situations, could offer a potential rationale for these results. The results are in line with Begum and Hamid, 2021, as districts with a high incidence of catastrophic health expenditure are also found to be situated near rivers [ 14 ]. These findings are consistent with previous research indicating that the prevalence of CHE varies geographically [ 28 ].…”

“…Similarly, Sheikh et al, 2022 reported that non-communicable diseases have higher OOP costs than communicable diseases, with cancer incurring the highest OOP cost, followed by liver disease and heart illness [ 12 ]. Regions with a high incidence of disease, such as river islands and water-submerged areas, have higher average OOP expenses [ 13 , 14 ]. In terms of spending, medicine costs account for approximately 60% of direct OOP expenditures [ 15 – 17 ].…”

Do hospitalizations push households into poverty in India: evidence from national data

“…OOP healthcare payments worsen both the occurrence and degree of poverty. 15 In India, majority of health insurance plans solely cover only hospitalization costs. 16 …”

“…OOP healthcare payments worsen both the occurrence and degree of poverty. 15 In India, majority of health insurance plans solely cover only hospitalization costs. 16 An expected situation in a country with a good health financial protection system is that no one should be forced into poverty as a result of incurring medical costs because of healthcare utilization.…”

Visual Storytelling for Knowledge Translation: A Study on BRAC’s Novel Health Loans in Protecting the Poor Against Health and Asset Vulnerability In Bangladesh

“…In Bangladesh, 67% of total health expenditure is out-of-pocket (9), accounting for 74% of household expenditure (10). As a result, about 13% (five million Bangladeshi) of the households in the country are trapped in poverty (11).…”