RE-THINKING UNMET HEALTHCARE NEEDS AND DYNAMICS OF OUT-OF-POCKET (OOP) EXPENDITURE IN BANGLADESH...
Author(s)
Abdur Razzaque Sarker, PhD.
Population Staudies Division, Bangladesh Institute of Development Studies, Dhaka, Bangladesh.
Population Staudies Division, Bangladesh Institute of Development Studies, Dhaka, Bangladesh.
OBJECTIVES: Despite improvements in many health indicators, out‑of‑pocket (OOP) expenditure remains a dominant payment mechanism for healthcare in Bangladesh, and its share has been rising at an alarming rate (79% in 2024). Reliance on OOP cost often leads to catastrophic healthcare expenditure and inability to pay may result in unmet need of care. This study aims to assess unmet healthcare needs, service utilization and examine inequality using benefit and financing incidence analysis.
METHODS: The study utilized data from the latest Household Income and Expenditure Survey (HIES) 2022, comprising 14,400 households and 62,387 individuals. Descriptive statistics were employed to analyses and summaries the percentage of unmet need, service utilization across providers. The distribution of benefits from public spending and progressivity/regressivity is assessed using Benefit and Financing Incidence Analysis.
RESULTS: Overall, 22% of the population reported a monthly need for healthcare, of whom 15% experienced unmet healthcare needs (representing 66% of total need). Unmet need was higher in rural areas compared to urban areas (70% vs. 60%). On average, Bangladeshi households spent BDT 3,454 per month on healthcare, accounting for 11% of total household expenditure. Medicines and diagnostic services were the largest cost drivers. The utilization of healthcare services in public facilities was distributed equitably, while healthcare services in private facilities were disproportionately concentrated among the wealthier. Despite higher absolute health expenditures among the richest group, the financial burden was significantly greater for poorer households (5% vs. 35% of total income). This indicates that the healthcare system in Bangladesh is regressive.
CONCLUSIONS: We observed a large proportion of the population still experiences unmet care although financial burden is heavier among poorest group. Therefore, policymakers should initiate health reforms for developing and implementing risk‐pooling financing mechanisms such as social health insurance to achieve Universal Health Coverage in Bangladesh
METHODS: The study utilized data from the latest Household Income and Expenditure Survey (HIES) 2022, comprising 14,400 households and 62,387 individuals. Descriptive statistics were employed to analyses and summaries the percentage of unmet need, service utilization across providers. The distribution of benefits from public spending and progressivity/regressivity is assessed using Benefit and Financing Incidence Analysis.
RESULTS: Overall, 22% of the population reported a monthly need for healthcare, of whom 15% experienced unmet healthcare needs (representing 66% of total need). Unmet need was higher in rural areas compared to urban areas (70% vs. 60%). On average, Bangladeshi households spent BDT 3,454 per month on healthcare, accounting for 11% of total household expenditure. Medicines and diagnostic services were the largest cost drivers. The utilization of healthcare services in public facilities was distributed equitably, while healthcare services in private facilities were disproportionately concentrated among the wealthier. Despite higher absolute health expenditures among the richest group, the financial burden was significantly greater for poorer households (5% vs. 35% of total income). This indicates that the healthcare system in Bangladesh is regressive.
CONCLUSIONS: We observed a large proportion of the population still experiences unmet care although financial burden is heavier among poorest group. Therefore, policymakers should initiate health reforms for developing and implementing risk‐pooling financing mechanisms such as social health insurance to achieve Universal Health Coverage in Bangladesh
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
HPR53
Topic
Health Policy & Regulatory
Topic Subcategory
Public Spending & National Health Expenditures
Disease
No Additional Disease & Conditions/Specialized Treatment Areas