Predictors of high out-of-pocket healthcare expenditure: an analysis using Bangladesh household income and expenditure survey, 2010

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Abstract

Background

Predictors of high out-of-pocket household healthcare expenditure are essential for creating effective health system finance policy. In Bangladesh, 63.3% of health expenditure is out-of-pocket and born by households. It is imperative to know what determines household health expenditure. This study aims to investigate the predicting factors of high out-of-pocket household healthcare expenditure targeting to put forward policy recommendations on equity in financial burden.

Methods

Bangladesh household income and expenditure survey 2010 provides data for this study. Predictors of high out-of-pocket household healthcare expenditure were analyzed using multiple linear regressions. We have modeled non-linear relationship using logarithmic form of linear regression. Heteroscedasticity and multicollinearity were checked using Breusch-Pagan/Cook-Weishberg and VIF tests. Normality of the residuals was checked using Kernel density curve. We applied required adjustment for survey data, so that standard errors and parameters estimation are valid.

Results

Presence of chronic disease and household income were found to be the most influential and statistically significant ( p < 0.001) predictors of high household healthcare expenditure. Households in rural areas spend 7% less than urban dwellers. The results show that a 100% increase in female members in a family leads to a 2% decrease in household health expenditure. Household income, health shocks in families, and family size are other statistically significant predictors of household healthcare expenditure. Proportion of elderly and under-five members in the family show some positive influence on health expenditure, though statistically nonsignificant.

Conclusions

The findings call for emphasizing prevention of chronic diseases, as it is a strong predictor of household health expenditure. Innovative insurance scheme needs to be devised to prevent household from being impoverished due to health shocks in the family. Policy makers are urged to design an alternative source of healthcare financing in Bangladesh to minimize the burden of high OOP healthcare expenditure.

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Most cited references 16

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What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?

Diane McIntyre, Michael Thiede, Göran Dahlgren … (2006)

This paper presents the findings of a critical review of studies carried out in low- and middle-income countries (LMICs) focusing on the economic consequences for households of illness and health care use. These include household level impacts of direct costs (medical treatment and related financial costs), indirect costs (productive time losses resulting from illness) and subsequent household responses. It highlights that health care financing strategies that place considerable emphasis on out-of-pocket payments can impoverish households. There is growing evidence of households being pushed into poverty or forced into deeper poverty when faced with substantial medical expenses, particularly when combined with a loss of household income due to ill-health. Health sector reforms in LMICs since the late 1980s have particularly focused on promoting user fees for public sector health services and increasing the role of the private for-profit sector in health care provision. This has increasingly placed the burden of paying for health care on individuals experiencing poor health. This trend seems to continue even though some countries and international organisations are considering a shift away from their previous pro-user fee agenda. Research into alternative health care financing strategies and related mechanisms for coping with the direct and indirect costs of illness is urgently required to inform the development of appropriate social policies to improve access to essential health services and break the vicious cycle between illness and poverty.

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Health-Related Financial Catastrophe, Inequality and Chronic Illness in Bangladesh

Md Mizanur Rahman, Stuart Gilmour, Eiko Saito … (2013)

Background Bangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP) payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk. Objective This study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe. Methods A cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively. Results On average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults. Conclusion Households that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by reducing the health system's dependency on OOP payments and providing more financial risk protection.

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Why do the sick not utilise health care? The case of Zambia.

Catharina Hjortsberg (2003)

When ill the individual faces the options of seeking health care, using self-medication or doing nothing. In an economic perspective, an individual's propensity to utilise health care is determined by the costs of utilisation and the perceived benefits of health care. The propensity to utilise health care may hence be expected to vary between individuals. In this paper we attempt on the one hand to determine what factors influence sick individuals' propensity to seek health care at a health facility or use self-medication (or do nothing), and on the other hand attempt to determine the factors that influence the magnitude of their expenditures for health care, in particular what other factors than just health status influence utilisation. For the empirical analysis, data, covering 9700 individuals, from the 1998 Living Conditions Monitoring Survey (LCMS) is used. We use a Multinomial Logit selection model to estimate the equation, which allows us to analyse health-care utilisation through two separate processes, the decision to seek care and the magnitude of expenditures incurred. In general, we find that the individuals are influenced by income, insurance, type of illness and access variables such as distance and owning a vehicle. Copyright 2003 John Wiley & Sons, Ltd.

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Author and article information

Contributors

Azaher Ali Molla: maazaher@gmail.com , mollaa@oregonstate.edu

Chunhuei Chi: Chunhuei.chi@oregonstate.edu

Alicia Lorena Núñez Mondaca: anunez@fen.uchile.cl

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 31 January 2017

Publication date PMC-release: 31 January 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 94

Affiliations

[1 ]ISNI 0000 0001 2112 1969, GRID grid.4391.f, , Oregon State University, ; 3405 NW Orchard Avenue, Apt. 106, Corvallis, OR 97330 USA

[2 ]ISNI 0000 0001 1498 6059, GRID grid.8198.8, Institute of Health Economics, , University of Dhaka, ; Dhaka, Bangladesh

[3 ]ISNI 0000 0001 2112 1969, GRID grid.4391.f, International Health Program, School of Biological and Population Health Sciences, , Oregon State University, ; Corvallis, OR 97330 USA

[4 ]ISNI 0000 0004 0385 4466, GRID grid.443909.3, Public Health, Department of Management Control and Information Systems, , University of Chile, ; Av. Diagonal Paraguay 257, Santiago, 8330015 Chile

Article

Publisher ID: 2047

DOI: 10.1186/s12913-017-2047-0

PMC ID: 5282811

PubMed ID: 28143517

SO-VID: 30b1cd3c-a8b0-402f-a621-888d5a969274

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 29 July 2016

Date accepted : 20 January 2017

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ScienceOpen disciplines: Health & Social care

Keywords: predictors of healthcare expenditure,out-of-pocket expenditure,health systems finance,health policy,household financial burden,chronic illness,rural-urban differentials

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ScienceOpen disciplines: Health & Social care

Keywords: predictors of healthcare expenditure, out-of-pocket expenditure, health systems finance, health policy, household financial burden, chronic illness, rural-urban differentials

Predictors of high out-of-pocket healthcare expenditure: an analysis using Bangladesh household income and expenditure survey, 2010

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International Journal of Applied Technology in Medical Sciences

Most cited references 16

What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?

Health-Related Financial Catastrophe, Inequality and Chronic Illness in Bangladesh

Why do the sick not utilise health care? The case of Zambia.

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