Presentation (CTI)

OBJECTIVES: International migrants play an important role in Bangladesh's economy, with remittances contributing 6% of GDP. While research on South Asia has focused on how remittances affect consumption, the relationship between migration and healthcare spending by left-behind family members is understudied. This paper examines whether international migration affects healthcare expenditure in migrant-sending households, and whether it shifts spending from informal self-treatment (medicines purchased directly, traditional treatment) toward formal medical care (doctor visits, hospitalization, medical tests). This matters for health policy in contexts where out-of-pocket payments form the majority of health spending and many households rely on pharmacies and traditional medicine rather than physicians and hospitals.
METHODS: Using data on 5,604 rural households from the 2018-19 Bangladesh Integrated Household Survey, I decompose total healthcare spending into formal and informal care. To address the endogeneity of migration, I use historic division-level migration rates as an instrument for a household's migrant status. I also test whether migrant-sending households have a higher burden of illness, which could independently drive both migration and healthcare spending.
RESULTS: I find no significant difference in illness days per capita between migrant-sending and non-migrant-sending households, suggesting spending differences do not reflect differential health burdens. The IV results show that international migration substantially increases healthcare spending, especially on formal care. The coefficient on formal care (5.15) exceeds that on informal care (3.07), pointing to a shift away from self-medication and traditional medicine. The relationship holds after accounting for illness burden. IV estimates exceed OLS estimates, suggesting households inclined to send migrants would otherwise have spent less on care.
CONCLUSIONS: International migration shifts healthcare spending toward formal care in migrant-sending households. These preliminary findings suggest remittances enable access to formal medical services otherwise forgone. Next steps include incorporating earlier survey rounds to exploit the panel structure.