Bangladesh’s 2018 out-of-pocket healthcare spending second highest in S Asia

Poor budgetary allocation in Bangladesh pushed people to spend 73.9% of the total healthcare expenditure from their pockets in 2018, which was the highest among eight South Asian countries, except for Afghanistan, says a report of the Asian Development Bank (ADB).

The healthcare sector in Bangladesh suffers deficient public funding and ineffective administration, the report says, highlighting that the country's public health expenditure as a percentage of GDP is significantly lower in South Asia.

It notes that high expenditure discourages the poor from seeking healthcare services, endangering their health immediately and foregoing opportunities for the early detection of preventable serious disease.

The lack of a meaningful national health insurance scheme confronts households with catastrophic healthcare payments that can impoverish them, forcing them to borrow money or sell household assets to finance health care, the report says.

The flagship report titled "Asian Development Outlook (ADO) 2021" was released globally on Wednesday, with ADB's Dhaka office publishing the report's Bangladesh chapter through a virtual press briefing.

ADB's Senior Economist Soon Chan Hong presented the summary of the report at the briefing and said out-of-pocket expenditure as a share of total health expenditure in Bangladesh had averaged 72.5% in five years from 2014 to 2018.

Citing the World Health Organisation (WHO) data, he said the out-of-pocket healthcare expenditure was 69.9% in 2014, which reached 73.9% in 2018.

According to WHO data, out-of-pocket healthcare expenditure in Afghanistan is 78% of total healthcare spending while it is 63% in India and 56% in Pakistan.

The out-of-pocket cost is only 13% in Bhutan, the lowest in South Asia, while it is 21% in the Maldives. People in Nepal and Sri Lanka have to bear 51% of their healthcare costs.

The ADB found that out-of-pocket expenditure in Bangladesh was 61% of the total healthcare cost in 2000 and the rate increased every year.

The report said private insurance is virtually nonexistent on a national scale and only a few large organisations provide health insurance through employers.

In the near absence of insurance schemes, the government and development partners have introduced programmes providing vouchers for maternal health care and financing to protect the most marginalised from catastrophic healthcare payments, it said.

The Eighth Five Year Plan of the government also expressed dissatisfaction over the lower budgetary allocation for the healthcare sector and higher healthcare spending to be borne by the people.

The plan revealed that public expenditure on the healthcare sector had remained virtually stagnant at 0.7% of GDP for a fairly long time, which needs immediate attention to be increased.

Moreover, continuously rising per capita out-of-pocket expenditure has been pushing the lower income and poor people into hardship.

"Although Bangladesh has made laudable progress in reducing poverty, every year, 7% of people are going down the poverty line for meeting healthcare expenses," explained the plan and recommended increasing government spending on health to 2% of the GDP by the fiscal year 2025.