Assessing the incidence of catastrophic health expenditure and impoverishment from out-of-pocket payments and their determinants in Bangladesh: evidence from the nationwide Household Income and Expenditure Survey 2016.

Autor: Ahmed S; Liverpool School of Tropical Medicine, Liverpool, UK.; Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.; Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City 700000, Vietnam.; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK., Ahmed MW; Health Economics and Financing Research, Health Systems and Population Studies Division, icddr, b, Dhaka, Bangladesh., Hasan MZ; Health Economics and Financing Research, Health Systems and Population Studies Division, icddr, b, Dhaka, Bangladesh., Mehdi GG; Health Economics and Financing Research, Health Systems and Population Studies Division, icddr, b, Dhaka, Bangladesh., Islam Z; Health Economics and Financing Research, Health Systems and Population Studies Division, icddr, b, Dhaka, Bangladesh., Rehnberg C; Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden., Niessen LW; Liverpool School of Tropical Medicine, Liverpool, UK.; Department of International Health, Johns Hopkins School of Public Health, USA., Khan JAM; Liverpool School of Tropical Medicine, Liverpool, UK.; Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.; School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
Jazyk: angličtina
Zdroj: International health [Int Health] 2022 Jan 19; Vol. 14 (1), pp. 84-96.
DOI: 10.1093/inthealth/ihab015
Abstrakt: Background: Out-of-pocket (OOP) payments for healthcare have been increasing steadily in Bangladesh, which deteriorates the financial risk protection of many households.
Methods: We aimed to investigate the incidence of catastrophic health expenditure (CHE) and impoverishment from OOP payments and their determinants. We employed nationally representative Household Income and Expenditure Survey 2016 data with a sample of 46 076 households. A household that made OOP payments of >10% of its total or 40% of its non-food expenditure was considered to be facing CHE. We estimated the impoverishment using both national and international poverty lines. Multiple logistic models were employed to identify the determinants of CHE and impoverishment.
Results: The incidence of CHE was estimated as 24.6% and 10.9% using 10% of the total and 40% of non-food expenditure as thresholds, respectively, and these were concentrated among the poor. About 4.5% of the population (8.61 million) fell into poverty during 2016. Utilization of private facilities, the presence of older people, chronic illness and geographical location were the main determinants of both CHE and impoverishment.
Conclusion: The financial hardship due to OOP payments was high and it should be reduced by regulating the private health sector and covering the care of older people and chronic illness by prepayment-financing mechanisms.
(© The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)
Databáze: MEDLINE
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