Catastrophic health expenditures and medical impoverishment in Bangladesh: evidence from the Household Income and Expenditure Survey.

OBJECTIVES

Catastrophic health expenditure (CHE) and impoverishment due to out-of-pocket (OOP) expenditure are the most widely used metrics to assess financial protection in health. This study aimed to investigate the impact of OOP expenditure on CHE and impoverishment in Bangladesh and identify their determinants.

DESIGN

A national cross-sectional survey.

SETTING

We used data from the latest Household Income and Expenditure Survey 2022 in Bangladesh.

PARTICIPANTS

14 395 households from eight administrative divisions in Bangladesh.

PRIMARY AND SECONDARY OUTCOME MEASURES: The well-known methodology developed by Wagstaff and Doorslaer was used in this study to estimate the prevalence of CHE and the effect of OOP spending on impoverishment. We used a generalised linear model with a log link and a gam ma distribution to assess the association between the explanatory variables and annual OOP expenditure.

RESULTS

The prevalence of CHE was estimated to be 17.72% (95% CI 17.71% to 17.73%) and 7.07% (95% CI 7.06% to 7.08%) using 10% and 25% of the total consumption expenditure as thresholds, respectively. Given the 40% of non-food expenditure threshold level, about 9.46% (95% CI 9.45% to 9.47%) of households faced CHE due to OOP expenditure in Bangladesh. In 2022, approximately 3.7% (95% CI 3.7% to 3.71%) of the population (6.13 million people) fell into poverty in Bangladesh. The prevalence of CHE was higher among male-headed households, larger families, households with elderly members, households with members suffering from chronic illnesses, those using hospital care and individuals in the poorest wealth quintiles.

CONCLUSIONS

Our study indicated that the financial burden due to OOP expenditure was substantial in Bangladesh. Findings stress the need for prepayment schemes such as national health insurance for safeguarding households against falling into poverty.