Determinants of health seeking behavior for chronic non-communicable diseases and related out-of-pocket expenditure: results from a cross-sectional survey in northern Bangladesh

Abstract

BackgroundIn spite of high prevalence rates, little is known about health seeking and related expenditure for chronic non-communicable diseases in low-income countries. We assessed relevant patterns of health seeking and related out-of-pocket expenditure in Bangladesh.MethodsWe used data from a household survey of 2500 households conducted in 2013 in Rangpur district. We employed multinomial logistic regression to assess factors associated with health seeking choices (no care or self-care, semi-qualified professional care, and qualified professional care). We used descriptive statistics (5% trimmed mean and range, median) to assess related patterns of out-of-pocket expenditure (including only direct costs).ResultsEight hundred sixty-six (12.5%) out of 6958 individuals reported at least one chronic non-communicable disease. Of these 866 individuals, 139 (16%) sought no care or self-care, 364 (42%) sought semi-qualified care, and 363 (42%) sought qualified care. Multivariate analysis confirmed that the following factors increased the likelihood of seeking qualified care: a higher education, a major chronic non-communicable disease, a higher socio-economic status, a lower proportion of chronic household patients, and a shorter distance between a household and a sub-district public referral health facility. Seven hundred fifty-four (87 %) individuals reported out-of-pocket expenditure, with drugs absorbing the largest portion (85%) of total expenditure. On average, qualified care seekers encountered the highest out-of-pocket expenditure, followed by those who sought semi-qualified care and no care, or self-care.ConclusionOur study reveals insufficiencies in health provision for chronic conditions, with more than half of all affected people still not seeking qualified care, and the majority still encountering considerable out-of-pocket expenditure. This calls for urgent measures to secure better access to care and financial protection.

Uneven economic burden of non-communicable diseases among Indian households: A comparative analysis

“…As per our findings, the economic burden of NCDs (measured in terms of OOPE) in public hospitals is more than twice for NCDs affected households as compared to non-NCDs households. In line with our findings, previous studies also found that NCDs affected households are spending comparatively higher OOPE than households with non-NCDs [44][45][46]. The share of medical expenditure is highest in the total expenditure followed by other non-medical and transport expenditure.…”

In-hospital and 30-day major adverse cardiac events in patients referred for ST-segment elevation myocardial infarction in Dhaka, Bangladesh

“…A quarter of our study participants had no formal education, and 41% had education only at the primary level (Table 1 ). Prevous studies in Bangladesh have documented a low level of education limiting access to healthcare and negatively affecting health care seeking decisions [ 56 , 57 ].…”

Prevalence of atopic dermatitis, asthma and rhinitis from infancy through adulthood in rural Bangladesh: a population-based, cross-sectional survey

“…Rasul et al found that within Bangladesh, higher educational attainment and socioeconomic status, shorter distance from the household to the health centre, and fewer household members with a chronic disease were associated with seeking care for a chronic non-communicable disease, such as asthma, from a qualified provider. 43 They also found a high burden of out-of-pocket medical expenditures, mostly related to pharmaceutical treatments. This supports our findings that those from the highest wealth quintiles were more likely to have received a diagnosis of their condition.…”