Unofficial Fees in Bangladesh: Price, Equity and Institutional Issues

Abstract

The widespread collection of unofficial fees at health facilities is a common form of rent-seeking behaviour in Bangladesh. Typically, unofficial fees come in the form of cash payments for the performance of required services, for direct purchase of drugs and medical-surgical requisites, and for service access. Using observational and interview methods, this study explores linkages between official and unofficial fees at three Bangladesh health facility levels; primary care Thana Health Complexes, secondary or district hospitals, and medical college hospitals. The study estimates payment levels for different income classes and different payor types at these facilities, thereby highlighting potential equity, price and institutional questions associated with unofficial fees. Not only does the practice have clear income and equity effects, there also appear to be direct effects upon patient satisfaction, perception of quality, and the ability to pay for health services. The article concludes with a discussion of 'rent capture' processes at Bangladesh facilities and the effect of unofficial fees in six areas of health sector reform: displaced official policies, reduced merit goods production, upward income redistribution, distorted human resource development, growth of facility inefficiency, and obstruction of market reforms.

Barriers to access in maternal healthcare services in the Northern Bangladesh

“…80 The study has also found a similar scenario and one participant complained that after she got admitted to a hospital she had to pay extra money for proper service and another reported that a surgeon delayed her operation for ransom just before her delivery time.…”

Self-reported illness and household strategies for coping with health-care payments in Bangladesh

“…One particularly disappointing observation made in the present study was that the costs of care from public health facilities in Bangladesh were high enough to require distress financing by many households, even though such facilities are heavily subsidized by the government. 32 This result indicates that health-care subsidization programmes in Bangladesh may not be working properly, especially among disadvantaged groups. One problem may be the inadequacy of the drugs and services available in public health facilities, which may be driving patients or their caregivers to purchase drugs and ancillary health services in the private market.…”

The Tremendous Cost of Seeking Hospital Obstetric Care in Bangladesh

“…[13][14][15][16][17][18][19] Rose-Ackerman argues that it is self-interest and greed that provoke individuals and groups to become involved in corruption. 19 Poor, salaried staff are vulnerable and easily bribed, but corrupt practices also serve the interests of highlevel off icials, 19 such as hospital administrators and doctors, who may not be directly involved.…”