Many don’t take medical care as out-of-pocket spending keeps rising

Every year some 16.4% of patients do not take healthcare services even though they need them as out-of-pocket expenditure in the percentage of total health expenditure has continued to rise in the country, says a report of the Health Economics Unit of the Ministry of Health and Family Welfare.

Currently, Bangladeshis have to pay 68.50% of their total treatment costs out of their own pockets, which previously was 67% – a rate already quite high compared to the world perspective, according to the report unveiled at a programme styled "Pathways to reduce household out-of-pocket expenditure" at Hotel InterContinental on Sunday.

The Health Economics Unit says patients spend a whopping 64% of their health expenses on drugs, while 23% used for meeting hospital expenses (both indoors and outdoors) and 8% for diagnosis purposes.

Only 3% patients receive medication from government hospitals and 14.9% obtain diagnostic services. Most patients have to buy medicines from private pharmacies and go to private diagnostic centres. This increases the out-of-pocket expenses of households and often leads them to face financial disaster.

In 2012, Bangladeshis spent 64% of their total health spending as out-of-pocket expenditure. That year, Bangladesh formulated the Health Care Financing Strategy 2012-32 by setting a target of reducing the out-of-pocket expenditure on health to 32% in 2032. However, instead of coming down, the rate increased to 67% in 2015 and now it has surged to 68.5%.

High out-of-pocket expenditure is the main obstacle to achieving sustainable development goals for Bangladesh.

To find a way out of this problem, the Health Economics Unit in collaboration with the World Bank has prepared the technical report.

At the report unveiling programme on Sunday, Dr Subrata Paul, focal person at the National Health Accounts Cell, presented the research paper entitled "Pathways to reduce high out-of-pocket healthcare" and said budgetary allocation for the health sector in Bangladesh is less as compared to other countries.

He, however, observed that it is not possible to solve this problem only by increasing the allocation of government funds. "We need to have the ability to spend so that the budget allocation does not remain unused."

He pointed out that with the introduction of social health insurance, many countries, including China and Thailand, have reduced the out-of-pocket health spending of patients.

Such insurance schemes can prove effective in the context of Bangladesh, he said, adding, "In order to reduce out-of-pocket expenses of patients, emphasis needs to be placed on strengthening primary healthcare services. In addition, drugs of non-communicable diseases need to be made available for people."

The research found that the out-pocket expenditure of a Covid patient taking services at a general bed in a government hospital was Tk6,376 while the expense was Tk2,42,074 at a private hospital.

On the other hand, a patient taking treatment in the ICU of a government hospital had to spend Tk33,333 out of their own pocket but the cost was Tk50,9,059 in a private hospital.

The government spent Tk1,28,109 for a patient in a general bed in a government hospital and Tk4,08,045 for an ICU patient.

Dr Nurul Amin, director-research (deputy secretary) at the Health Economics Unit, Ministry of Health presented the second research paper on "Diagnosing the underlying factors of high out-of-pocket expenditure of health".

Dr Nurul Amin, Director Research (Deputy Secretary) Health Economics Unit, presented the second research paper entitled "Diagnosing the underlying factors of high out-of-pocket (OOP) expenditure of health'" at the programme.

According to the article, patients are forced to seek services from private hospitals due to an ineffectual public primary healthcare system at the village level and an inadequacy of primary healthcare systems in urban areas. In addition, government hospitals do not provide all the necessary medicines and there are not enough diagnostic facilities.

Dr Nurul Amin said because of apparent no bar to buying any medicines including antibiotics without having prescriptions and too much marketing by pharmaceutical companies, reputed doctors as well as charlatans prescribe excessive medicines.

"Patients' expenses increase because of taking more medicines than what is required. This cost can be curbed if the use of 'generic names' of drugs instead of their "brand names" is made compulsory by revising and expanding the list of emergency medicines and following the protocol in the prescription."

He further said that due to a lack of necessary monitoring over the quality and price of services in private hospitals, people receiving services are constantly being harmed in various ways.

Patients' dissatisfaction and sometimes a lack of trust in that regard encourages them to seek services from abroad. To meet medical expenses in this way, many people become penniless, losing all their belongings including residential land.

The Health Economics Unit also put forward a set of recommendations to reduce out-of-pocket health expenditure of households and save them from financial catastrophe.

These include introduction of an integrated service system between community clinics and upazila health complexes through introduction of e-health; enhancing the capacity of government healthcare centres to the desired level by recruiting and deploying the required manpower, ensuring testing facilities and providing adequate medicines; introduction of the accreditation system for private hospitals and increase the government's capacity to control the cost and quality of services.

Health Minister Zahid Maleque said, "It is important to promote health awareness among people. Preventing environmental pollution is important as well."

"We are working to keep the medicine cost on a leash, which has been the highest. Non-curable diseases that require lifetime drug-dependency add to this high expenditure rate," the minister said.

Receiving treatment abroad is one of the reasons behind the rise in out-of-pocket expenditure, he observed.

Cancer and cardiovascular treatments need to improve, the minister said, hoping that eight new cancer hospitals that are on the cards will reduce the cost burden in the future.

The minister further suggested that people need to adapt to the annual health check-up culture.