Benefit incidence analysis of healthcare in Bangladesh – equity matters for universal health coverage

Khan, Jahangir; Ahmed, Sayem; MacLennan, Mary; Sarker, Abdur Razzaque; Sultana, Marufa; Rahman, Hafizur

doi:10.1093/heapol/czw131

Cited by 27 publications

(35 citation statements)

References 19 publications

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“…The benefit equity of GHS and pattern of healthcare utilization across socioeconomic groups are two key measures. It is expected that every Chinese people not only gets financial protection but also has access to needed health care [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Estimating benefit equity of government health subsidy in healthcare Services in Shandong Province, China: a cross-sectional study

Qin

et al. 2018

Int J Equity Health

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BackgroundGovernment health subsidy (GHS) is an effective tool to improve population health in China. Ensuring an equitable allocation of GHS, particularly among the poorer socio-economic groups, is a major goal of China’s healthcare reform.The paper aims to explore how GHS was allocated across different socioeconomic groups, and how well the overall health system was performing in terms of the allocation of subsidy for different types of health services.MethodsData from China’s National Health Services Survey (NHSS) in 2013 were used. Benefit incidence analysis (BIA) was applied to examine if GHS was equally distributed across income quintile. Benefit incidence was presented as each quintile’s percentage share of total benefits, and the concentration index (CI) and Kakwani index (KI) were calculated. Health benefits from three types of healthcare services (primary health care, outpatient and inpatient services) were analyzed, separated into urban and rural populations. In addition, the distribution of benefits was compared to the distribution of healthcare need (measured by self-reported illness and chronic disease) across income quintiles.ResultsIn urban populations, the CI value of GHS for primary care was negative. (− 0.14), implying an allocation tendency toward poor region; the CI values of outpatient and inpatient services were both positive (0.174 and 0.194), indicating allocation tendencies toward rich region. Similar allocation pattern was observed in rural population, with pro-poor tendency of primary care service (CI = − 0.082), and pro-rich tendencies of outpatient (CI = 0.153) and inpatient services (CI = 0.203). All the KI values of three health services in urban and rural populations were negative (− 0.4991,-0.1851 and − 0.1651; − 0.482, − 0.247and − 0.197), indicating that government health subsidy was progressive and contributed to the narrowing of economic gap between the poor and rich.ConclusionsThe inequitable distribution of GHS in China exited in different healthcare services; however, the GHS benefit is generally progressive. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.

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Section: Discussionmentioning

confidence: 99%

Estimating benefit equity of government health subsidy in healthcare Services in Shandong Province, China: a cross-sectional study

Qin

et al. 2018

Int J Equity Health

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“…While each country must decide its own path towards UHC based on the individual country contexts, all should draw on existing evidence and shared experience. Currently available evidences from Bangladesh on UHC mostly include quantitative household surveys on out of pocket expenditure [14,15], financial risk protection [6,[15][16][17], and equity analysis [6,[16][17][18]. The policy environment around UHC issues has been analyzed by very few studies, which includes an assessment of a set of proposed indicators related to UHC [19,20], and generic policy papers without description of methodology [21,22].…”

Section: Introductionmentioning

confidence: 99%

Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions

Joarder¹,

Chaudhury

Mannan

2019

Advances in Public Health

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Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. Inequity is present in most of health indicators across social, economic, and demographic parameters. This study explores the existing health policy environment and current activities to further the progress towards Universal Health Coverage (UHC) and the challenges faced in these endeavors. This qualitative study involved document reviews (n=22) and key informant interviews (KII, n=15). Thematic analysis of texts (themes: activities around UHC, implementation barriers, suggestions) was done using the manual coding technique. We found that Bangladesh has a comprehensive set of policies for UHC, e.g., a health-financing strategy and staged recommendations for pooling of funds to create a national health insurance scheme and expand financial protection for health. Progress has been made in a number of areas including the roll out of the essential package of health services for all, expansion of access to primary health care services (support by donors), and the piloting of health insurance which has been piloted in three subdistricts. Political commitment for these areas is strong. However, there are barriers pertaining to the larger policy level which includes a rigid public financing structure dating from the colonial era. While others pertain to the health sector’s implementation shortfalls including issues of human resources, political interference, monitoring, and supervision, most key informants discussed demand-side barriers too, such as sociocultural disinclination, historical mistrust, and lack of empowerment. To overcome these, several policies have been recommended, e.g., redesigning the public finance structure, improving governance and regulatory mechanism, specifying code of conduct for service providers, introducing health-financing reform, and collaborating with different sectors. To address the implementation barriers, recommendations include improving service quality, strengthening overall health systems, improving health service management, and improving monitoring and supervision. Addressing demand-side barriers, such as patient education and community empowerment, is also needed. Research and advocacy are required to address crosscutting barriers such as the lack of common understanding of UHC.

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“…As such, maternal care‐related financial and well‐being costs might be devastating and could significantly impact the livelihoods of family members by causing economic disruption. Indeed, in the case of Bangladesh, many households experience catastrophic economic burden and fall into poverty due to these expenses . Households often mitigate this excessive expenditure by borrowing, selling assets, or using savings, donation from relatives, bank loans, and relying on transfers .…”

Section: Introductionmentioning

confidence: 99%

Cost comparison and determinants of out‐of‐pocket payments on child delivery care in Bangladesh

Sarker

Sultana

Ali

et al. 2018

Health Planning & Management

Self Cite

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The study showed that there was a huge variation of OOP, which was dependent on the facility and socioeconomic demographic status of the households. As such, policy efforts need to focus on lowest wealth quintiles to avoid economic burdens during child delivery-related activities, and therefore, financial risk protection should be provided. Social health insurance might be an option for financing during child delivery, which is in line with the core objective of the Healthcare Financing Strategy of Bangladesh, which is to achieve universal health coverage.

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Benefit incidence analysis of healthcare in Bangladesh – equity matters for universal health coverage

Abstract: Background: Equity in access to and utilization of healthcare is an important goal for any

Cited by 27 publications

References 19 publications

Estimating benefit equity of government health subsidy in healthcare Services in Shandong Province, China: a cross-sectional study

Estimating benefit equity of government health subsidy in healthcare Services in Shandong Province, China: a cross-sectional study

Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions

Cost comparison and determinants of out‐of‐pocket payments on child delivery care in Bangladesh

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