Nearly 42 per cent of the country’s population faces financial hardship when paying for medical treatment. In 2022 alone, healthcare expenses pushed 7.2 million people below the poverty line.
These findings emerged from a study by the Health Economics Unit of the Ministry of Health. The study found that the burden of medical expenses falls most heavily on the poor, with a large share of out-of-pocket spending going towards medicines.
The World Health Organization (WHO) and the Swedish Embassy supported the Health Economics Unit in conducting the study. Its findings were presented at a hotel in the capital on Wednesday. The study used data from the Bangladesh Bureau of Statistics’ (BBS) Household Income and Expenditure Surveys conducted in 2005, 2010, 2016 and 2022.
The aim was to examine how much people spend out of their own pockets when seeking healthcare, which aspects of treatment account for their spending, and how heavily these expenses affect them.
State Minister for Health MA Muhith, the chief guest at the event, said the findings offered a striking illustration of the dire state of the health sector. The BNP was in power at the beginning of the 17-year period from 2005 to 2022, while a “fascist government” was in power for the remaining years. Therefore, he argued, the BNP government could not be held responsible for the picture that emerged from the study.
The problem is getting worse
At the beginning of the presentation, Subrata Pal, focal point for the Bangladesh National Health Accounts at the Health Economics Unit, said the country faced a contradiction in terms of financial protection.
In 2005, 40 per cent of the population was poor. By 2022, that figure had fallen to 18.7 per cent. Yet the proportion of people experiencing financial hardship or pressure rose from 12.5 per cent in 2005 to 32.1 per cent in 2022. In other words, the share of people living in poverty has declined, while the number facing financial pressure has increased.
The study found that financial hardship caused by healthcare expenses continues to grow. In 2005, 28.2 per cent of the population faced financial hardship due to medical costs. The situation has since worsened: by 2022, 41.7 per cent of people were under financial pressure while trying to pay for healthcare.
This burden affects all sections of society, including the rich, the middle class and the poor. Such financial pressure can push people below the poverty line. In 2022, healthcare expenses alone drove 7.2 million people below the poverty line, largely because a substantial portion of medical costs had to be paid out of their own pockets.
Where the Money Goes
The study did not present figures showing the amount or proportion of total healthcare expenditure paid directly by individuals. Calculating out-of-pocket expenditure (OOP) was not the study’s objective. However, it did estimate how many people pay for treatment out of their own pockets and how that money is spent.
In 2005, 52.5 per cent of people paid for medical treatment out of their own pockets. The proportion increased steadily, reaching 92.7 per cent in 2022. In 2005, the average out-of-pocket medical expenditure per household was Tk 709. By 2022, it had risen to Tk 3,493. Those who do not pay out of pocket are assumed to receive free treatment at government hospitals or NGO-run health centres.
Medicines and diagnostic tests account for the largest shares of medical expenses. In 2022, patients visiting hospital outpatient departments spent 74 per cent of their total treatment costs on medicines, while medicines accounted for 35 per cent of the expenses incurred by admitted patients. Diagnostic tests accounted for 11 per cent of out-of-pocket spending by outpatients and 22 per cent by admitted patients. Other expenses included doctors’ consultations, hospital stays and transportation.
The study also found that private hospitals are more expensive than public facilities. In 2022, the average out-of-pocket expenditure for a patient receiving treatment at a government hospital was Tk 2,688, compared with Tk 4,808 at a private hospital.
For patients admitted to hospital, the average cost was Tk 21,547 at a government hospital and Tk 32,517 at a private hospital. The average cost for admission to an NGO-run hospital was Tk 22,028.
Why Financial Hardship Is Increasing
Researchers identified several factors behind the rise in out-of-pocket spending and financial hardship.
Healthcare costs are rising faster than household incomes. The study found that household income increased by 38 per cent between 2016 and 2022, while healthcare expenditure rose by 43 per cent over the same period.
The proportion of patients requiring hospital admission has also increased. In 2016, 8.1 per cent of patients seeking treatment were admitted to hospital. By 2022, the figure had risen to 12.4 per cent. Hospital admission generally means higher out-of-pocket expenses for patients.
Another factor is the declining proportion of patients seeking treatment at government hospitals. In 2016, 15.1 per cent of patients chose government hospitals for treatment. By 2022, that share had fallen to 10.9 per cent.
At the same time, people have become increasingly reliant on pharmacies. In 2016, 32.5 per cent of people turned to pharmacies for treatment. By 2022, the proportion had risen to 55.4 per cent.
The growing prevalence of chronic diseases is another reason for the increase in financial hardship. In 2005, 44.7 per cent of patients suffered from chronic diseases. By 2022, the figure had risen to 72.4 per cent. People with chronic conditions need to take medication over long periods, and some must pay for medicines for the rest of their lives.
The Burden Is Not the Same Everywhere
People in different parts of the country do not experience the financial burden of healthcare equally. The regional pattern has also changed over time.
In 2005, the proportion of people facing financial hardship due to medical expenses was highest in Rajshahi Division and lowest in Barishal Division. By 2022, however, Barishal had the highest proportion of people experiencing financial hardship while seeking treatment, while Dhaka Division had the lowest.
Rural residents are more likely than urban residents to face financial hardship when seeking medical care. People in rural areas also spend more out of their own pockets on treatment than those living in cities.
Researchers found that healthcare-related financial hardship is concentrated mainly among the poorest sections of society. The burden affects 90.8 per cent of people in the poorest group, compared with 13.6 per cent among the wealthiest.
Would increasing government allocations to the health sector solve the problem? Researchers said there was no guarantee that simply increasing public funding would ensure that poorer people benefited adequately.
The event opened with welcome remarks from S M Abu Horayra, director (research) of the Health Economics Unit. Mohammad Touhidul Islam, a national programme officer at the WHO, spoke about indicators under the Sustainable Development Goals (SDGs). Sayem Ahmed, a national consultant for the WHO, presented the study’s methodology online from the United Kingdom.
Public health experts, health economists, university teachers, representatives of donor agencies and officials from private organisations attended the event.
The event was chaired by Mohammad Enamul Haque, director general of the Health Economics Unit. He said the study had brought to light some harsh truths that could not be denied. The research itself, he added, contained pathways towards solutions.