Inequity in Public Healthcare Utilization Among Persons With Disabilities in Bangladesh: A Benefit Incidence Analysis
Author(s)
Md Raisul Akram, PhD student.
Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom.
Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom.
OBJECTIVES: Understanding disparities in healthcare access and benefit distribution is critical for promoting equitable service delivery, particularly for persons with disabilities (PWDs) in low-income settings. This study aims to investigate the inequities in healthcare services use and public benefit distribution among PWDs in Bangladesh.
METHODS: This study analysed secondary data from the 2022 Household Income and Expenditure Survey. The analysis focused on individuals with available disability-related data, who reported illnesses and utilised healthcare in the 30 days preceding the survey. Socio-economic inequalities in healthcare utilisation were assessed using concentration indices (CIs), while benefit incidence analysis (BIA) and concentration curves (CCs) evaluated inequities in benefit distribution relative to disease burden across asset quintiles.
RESULTS: Among the 60,576 study participants, 3,371 were disabled (5.56%), 25.01% of PWDs reported recent illness, and 92.41% of them sought care, mostly from traditional and non-qualified providers (59.88%), followed by private (25.85%) and public facilities (14.27%). Traditional provider utilisation among PWDs declined with socio-economic status (from 70.74% to 42.96%), while private provider utilisation rose (16.49% to 40.00%). Public facility utilisation remained stable (12.77%-17.04%). Equity analysis indicated that private care was pro-rich (CI=0.18), traditional pro-poor (CI=-0.10), while no significant inequities were observed for public healthcare. The overall population showed similar but slightly stronger pro-rich patterns. Healthcare benefit distribution was inequitable. The poorest PWDs bore 22.83% of the disease burden; however, received only 15.96% of benefits compared to the richest (burden: 17.72%; received subsidies: 18.95%).
CONCLUSIONS: Significant pro-rich disparities in public healthcare utilisation and benefit distribution persist in Bangladesh, disproportionately affecting the poorest PWDs. Achieving equitable, disability-inclusive health coverage in Bangladesh will require pro-poor financing and targeted reforms to ensure that public services and subsidies align with the needs of the most vulnerable PWDs.
METHODS: This study analysed secondary data from the 2022 Household Income and Expenditure Survey. The analysis focused on individuals with available disability-related data, who reported illnesses and utilised healthcare in the 30 days preceding the survey. Socio-economic inequalities in healthcare utilisation were assessed using concentration indices (CIs), while benefit incidence analysis (BIA) and concentration curves (CCs) evaluated inequities in benefit distribution relative to disease burden across asset quintiles.
RESULTS: Among the 60,576 study participants, 3,371 were disabled (5.56%), 25.01% of PWDs reported recent illness, and 92.41% of them sought care, mostly from traditional and non-qualified providers (59.88%), followed by private (25.85%) and public facilities (14.27%). Traditional provider utilisation among PWDs declined with socio-economic status (from 70.74% to 42.96%), while private provider utilisation rose (16.49% to 40.00%). Public facility utilisation remained stable (12.77%-17.04%). Equity analysis indicated that private care was pro-rich (CI=0.18), traditional pro-poor (CI=-0.10), while no significant inequities were observed for public healthcare. The overall population showed similar but slightly stronger pro-rich patterns. Healthcare benefit distribution was inequitable. The poorest PWDs bore 22.83% of the disease burden; however, received only 15.96% of benefits compared to the richest (burden: 17.72%; received subsidies: 18.95%).
CONCLUSIONS: Significant pro-rich disparities in public healthcare utilisation and benefit distribution persist in Bangladesh, disproportionately affecting the poorest PWDs. Achieving equitable, disability-inclusive health coverage in Bangladesh will require pro-poor financing and targeted reforms to ensure that public services and subsidies align with the needs of the most vulnerable PWDs.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD63
Topic
Health Service Delivery & Process of Care