Health Expenses: People dig deeper into their pockets

Bangladesh's out-of-pocket (OOP) healthcare expenditure has continued to rise, leaving a sizeable population with catastrophic medical bills, found a recent study by the health ministry.

Between 2015 to 2020, the OOP -- which is the expense for treatment borne directly by a patient where neither public nor private insurance covers the full cost of the health good or service -- has increased to 68.5 percent from 67 percent, according to the study.

This is the highest among Saarc nations, said the technical study conducted by the Health Economics Unit (HEU) of the health ministry to bring down OOP in the country. The findings of the study were shared yesterday at an event styled "Pathways to Reduce Household OOP Expenditure".

Thanks to the rising OOP, 16.4 percent of the households avoid getting medical help even when needed, 24.4 percent of families (at 10 percent income level) are facing catastrophic health bills and 4.5 percent of the people are pushed into poverty every year.

About 64 percent of the OOP expenditure goes for medicine, whereas it is 28 percent in India.

The excessive outlay on medicine is because of two reasons: irrational prescription and aggressive marketing, said Md Nurul Amin, director of research at HEU, in his keynote presentation at the event.

As much as 60 percent of the patients take medicines by self-medication and excessive prescription by informal providers like drug sellers and quacks, while 25 percent of the patients are victims of prescription of costly non-listed drugs.

About 58 percent of the employees of pharmaceutical companies are engaged in marketing and distribution, found the study. For instance, in 2010, 27 percent of the pharmaceutical companies' revenue was spent on marketing.

To curtail the cost of medicine, the researchers recommended revising and expanding the list of emergency medicines and following the treatment protocol by the physicians.

Inpatient and outpatient services account for 12 percent and 11 percent of OOP expenditure respectively.

There is a target to halve the OOP expenditure to 32 percent by 2032, according to the Health Financing Strategy 2012-2032.

But, it is on the rise, meaning Bangladesh's target for Universal Health Coverage (UHC) by 2032 is unlikely to be met.

Financial risk protection for the people is one of the three aspects for UHC and the country is worse day by day in this. It has done well in terms of population coverage, service coverage.

The excessive tests for diagnosis are one of the main causes for increased OOP, said Health Minister Zahid Maleque at the event.

Disease diagnosis accounts for 8 percent of OOP expenditure.

"We are working to reduce the diagnosis cost. I would urge the private healthcare service providers for help in this regard," he added.

Patients are forced to seek services from private diagnostic centres and hospitals due to inadequate primary healthcare systems in rural and urban areas.

Statistics show that only 3 percent of the patients get medicine from the government hospitals while only 14.9 percent of the tests are done there, Amin said.

To eliminate poverty, there is no alternative to addressing the underlying factors of high OOP, he told The Daily Star.

To reduce the OOP expenditure, the researchers recommended coordination between community clinics and Upazila Health Complexes by introducing e-health services, ensuring efficiency of the public healthcare facilities and introducing social health insurance system.

They also recommended introducing an accreditation system for private healthcare facilities to control healthcare costs and standards and making use of generic names in prescriptions mandatory to discourage the drug-makers from aggressive marketing.