Dhaka:Out-of-Pocket (OOP) healthcare payments in Bangladesh have pushed an estimated 11 million people below the national poverty line over the past 17 years until 2022, with over four in every ten Bangladeshis (41.7%) experiencing financial hardship due to health spending.
According to Bangladesh Sangbad Sangstha, a new study conducted by the Health Economics Unit of the Ministry of Health and Family Welfare and the World Health Organization (WHO) Bangladesh revealed this information. The study analyzed nationally representative Household Income and Expenditure Survey (HIES) data from 2005, 2010, 2016, and 2022, with findings released at an event titled "Assessment of Financial Hardship Associated with Healthcare Out-of-Pocket Payments and Benefit Incidence in Bangladesh" at a city hotel.
The study found that average monthly OOP expenditure increased from Taka 1,241 in 2005 to Taka 3,238 in 2022 in real terms. The proportion of households reporting any health-related OOP payment rose significantly from 52.5 percent to 92.7 percent, indicating that Bangladesh's progress in poverty reduction and health indicators has not been matched by adequate financial protection against healthcare expenditure.
The findings suggested that although the national poverty rate declined from 40 percent in 2005 to 18.7 percent in 2022, healthcare spending continues to drive many households into poverty. Financial hardship associated with out-of-pocket health spending increased from 28.2 percent in 2005 to 41.7 percent in 2022, which is higher than the current global estimate of approximately 26 percent.
The burden of OOP healthcare payments is particularly severe among poorer households, with 90.8 percent of people in the poorest consumption quintile facing financial hardship from health expenditures in 2022, compared to 13.6 percent in the richest quintile. The financial strain was especially pronounced among rural households (47.9 percent) compared to urban households (28.2 percent).
The study identified rising reliance on private providers and pharmacies/drug retailers as a significant contributor to household OOP health expenditures. Private healthcare utilization was associated with substantially higher costs. The use of pharmacies as a source of outpatient care increased from 32.5 percent in 2016 to 55.4 percent in 2022, while public facility utilization decreased.
The study calls for a comprehensive health financing mechanism to strengthen financial risk protection and progress towards Universal Health Coverage (UHC). Key recommendations include increasing public investment in health, improving public spending efficiency and equity, and expanding pooled financing mechanisms.
The report emphasized the need for reliable access to essential medicines and diagnostic services in public facilities, strengthening primary healthcare, and expanding publicly financed protection for high-cost inpatient care. It also recommended stronger regulation of private providers and pharmacies, targeted resources for disadvantaged populations, and a pro-poor distribution of public health benefits.