Journal of Preventive Medicine and Public Health

  • 제50권2호
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  • Pages.91-99
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  • 2017
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  • 1975-8375(pISSN)
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  • 2233-4521(eISSN)
대한예방의학회 (The Korean Society for Preventive Medicine)
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Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh

  • Mahumud, Rashidul Alam (Health Economics and Financing Research, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research) ;
  • Sarker, Abdur Razzaque (Health Economics and Financing Research, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research) ;
  • Sultana, Marufa (Health Economics and Financing Research, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research) ;
  • Islam, Ziaul (Health Economics and Financing Research, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research) ;
  • Khan, Jahangir (Liverpool School of Tropical Medicine, Pembroke Place) ;
  • Morton, Alec (Department of Management Science, University of Strathclyde Business School)
  • 투고 : 2016.09.20
  • 심사 : 2017.02.07
  • 발행 : 2017.03.31
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초록

Objectives: As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods: A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results: The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions: The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

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참고문헌

  1. Saito E, Gilmour S, Rahman MM, Gautam GS, Shrestha PK, Shibuya K. Catastrophic household expenditure on health in Nepal: a cross-sectional survey. Bull World Health Organ 2014;92(10):760-767. https://doi.org/10.2471/BLT.13.126615
  2. Majumder MA. Economics of healthcare financing in WHO South East Asia Region. South East Asia J Public Health 2012;2(2):3-4.
  3. Ministry of Health and Family Welfare. Bangladesh national health accounts 1997-2012; 2015 [cited 2017 Mar 15]. Available from: http://www.heu.gov.bd/pdf/bnha%201997-2012.pdf.
  4. Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Aff (Millwood) 2007;26(4):972-983. https://doi.org/10.1377/hlthaff.26.4.972
  5. van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, et al. Catastrophic payments for health care in Asia. Health Econ 2007;16(11):1159-1184. https://doi.org/10.1002/hec.1209
  6. World Health Organization. The world health report: health systems financing: the path to universal coverage; 2010 [cited 2017 Feb 28]. Available from: http://apps.who.int/iris/bitstream/10665/44371/1/9789241564021_eng.pdf.
  7. da Silva MT, Barros AJ, Bertoldi AD, de Andrade Jacinto P, Matijasevich A, Santos IS, et al. Determinants of out-of-pocket health expenditure on children: an analysis of the 2004 Pelotas Birth Cohort. Int J Equity Health 2015;14:53. https://doi.org/10.1186/s12939-015-0180-0
  8. Garg CC, Karan AK. Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India. Health Policy Plan 2009;24(2):116-128. https://doi.org/10.1093/heapol/czn046
  9. Chu TB, Liu TC, Chen CS, Tsai YW, Chiu WT. Household out-ofpocket medical expenditures and National Health Insurance in Taiwan: income and regional inequality. BMC Health Serv Res 2005;5:60. https://doi.org/10.1186/1472-6963-5-60
  10. Rous JJ, Hotchkiss DR. Estimation of the determinants of household health care expenditures in Nepal with controls for endogenous illness and provider choice. Health Econ 2003;12(6):431-451. https://doi.org/10.1002/hec.727
  11. Muhammad Malik A, Azam Syed SI. Socio-economic determinants of household out-of-pocket payments on healthcare in Pakistan. Int J Equity Health 2012;11:51. https://doi.org/10.1186/1475-9276-11-51
  12. Kawabata K, Xu K, Carrin G. Preventing impoverishment through protection against catastrophic health expenditure. Bull World Health Organ 2002;80(8):612.
  13. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet 2003;362(9378):111-117. https://doi.org/10.1016/S0140-6736(03)13861-5
  14. Kien VD, Van Minh H, Giang KB, Dao A, Tuan LT, Ng N. Socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with non-communicable diseases in urban Hanoi, Vietnam. Int J Equity Health 2016;15(1):169. https://doi.org/10.1186/s12939-016-0460-3
  15. Lee WY, Shaw I. The impact of out-of-pocket payments on health care inequity: the case of national health insurance in South Korea. Int J Environ Res Public Health 2014;11(7):7304-7318. https://doi.org/10.3390/ijerph110707304
  16. Waters HR, Anderson GF, Mays J. Measuring financial protection in health in the United States. Health Policy 2004;69(3):339-349. https://doi.org/10.1016/j.healthpol.2004.01.003
  17. Wagstaff A, Doorslaer EV. Equity in healthcare financing and delivery. In: Culver AJ, Newhouse JP, editors. Handbook of health economics. 1st ed. Amsterdam: Elsevier; 2000, p. 1-62.
  18. Bangladesh Bureau of Statistics. Bangladesh of the household income & expenditure survey 2010; 2011 [cited 2017 Jan 20]. Available from: http://203.112.218.65/WebTestApplication/userfiles/Image/LatestReports/HIES-10.pdf.
  19. Sarker AR, Mahumud RA, Sultana M, Ahmed S, Ahmed W, Khan JA. The impact of age and sex on healthcare expenditure of households in Bangladesh. Springerplus 2014;3:435. https://doi.org/10.1186/2193-1801-3-435
  20. Hossain MG, Saw A, Alam R, Ohtsuki F, Kamarul T. Multiple regression analysis of anthropometric measurements influencing the cephalic index of male Japanese university students. Singapore Med J 2013;54(9):516-520. https://doi.org/10.11622/smedj.2013175
  21. Mustard CA, Kaufert P, Kozyrskyj A, Mayer T. Sex differences in the use of health care services. N Engl J Med 1998;338(23):1678-1683. https://doi.org/10.1056/NEJM199806043382307
  22. Bekelman JE, Halpern SD, Blankart CR, Bynum JP, Cohen J, Fowler R, et al. Comparison of site of death, health care utilization, and hospital expenditures for patients dying with cancer in 7 developed countries. JAMA 2016;315(3):272-283. https://doi.org/10.1001/jama.2015.18603
  23. Li Y, Wu Q, Xu L, Legge D, Hao Y, Gao L, et al. Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance. Bull World Health Organ 2012;90(9):664-671. https://doi.org/10.2471/BLT.12.102178
  24. Jiang C, Ma J, Zhang X, Luo W. Measuring financial protection for health in families with chronic conditions in rural China. BMC Public Health 2012;12:988. https://doi.org/10.1186/1471-2458-12-988
  25. Shi W, Chongsuvivatwong V, Geater A, Zhang J, Zhang H, Brombal D. Effect of household and village characteristics on financial catastrophe and impoverishment due to health care spending in western and central rural China: a multilevel analysis. Health Res Policy Syst 2011;9:16. https://doi.org/10.1186/1478-4505-9-16
  26. Alemayehu B, Warner KE. The lifetime distribution of health care costs. Health Serv Res 2004;39(3):627-642. https://doi.org/10.1111/j.1475-6773.2004.00248.x
  27. Sarker AR, Islam Z, Khan IA, Saha A, Chowdhury F, Khan AI, et al. Cost of illness for cholera in a high risk urban area in Bangladesh: an analysis from household perspective. BMC Infect Dis 2013;13:518. https://doi.org/10.1186/1471-2334-13-518
  28. Hoque ME, Dasgupta SK, Naznin E, Al Mamun A. Household coping strategies for delivery and related healthcare cost: findings from rural Bangladesh. Trop Med Int Health 2015;20(10):1368-1375. https://doi.org/10.1111/tmi.12546
  29. Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ 2007;85(10):812-819. https://doi.org/10.2471/BLT.06.035659
  30. Daga S, Mhatre S, Dsouza E. Out-of-pocket nonmedical expenses associated with out-patient treatment of common childhood illnesses. J Trop Pediatr 2015;61(3):226-228. https://doi.org/10.1093/tropej/fmv014
  31. Ilunga-Ilunga F, Leveque A, Laokri S, Dramaix M. Incidence of catastrophic health expenditures for households: an example of medical attention for the treatment of severe childhood malaria in Kinshasa reference hospitals, Democratic Republic of Congo. J Infect Public Health 2015;8(2):136-144. https://doi.org/10.1016/j.jiph.2014.08.008
  32. Onwujekwe OE, Uzochukwu BS, Obikeze EN, Okoronkwo I, Ochonma OG, Onoka CA, et al. Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria. BMC Health Serv Res 2010;10:67. https://doi.org/10.1186/1472-6963-10-67
  33. Verhagen LM, Kapinga R, van Rosmalen-Nooijens KA. Factors underlying diagnostic delay in tuberculosis patients in a rural area in Tanzania: a qualitative approach. Infection 2010;38(6):433-446. https://doi.org/10.1007/s15010-010-0051-y

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