Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing

Molla, Azaher Ali; Chi, Chunhuei

doi:10.1186/s12939-017-0654-3

Cited by 39 publications

(30 citation statements)

References 27 publications

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“…Our findings also indicated negative coefficients of the KPIs for the OOP payment for healthcare across the years and the categories, indicating the regressivity of the households’ OOP payments for healthcare services. These findings are consistent with the reports of other several studies [ 6 , 16 – 18 , 27 ]. Another study in Africa also reported a negative coefficient (KPI = − 0.20) of the OOP for healthcare [ 28 ].…”

Section: Discussionsupporting

confidence: 94%

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Rezaei

Woldemichael

Ebrahimi

et al. 2020

J. Egypt. Public. Health. Assoc.

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Background Equity in the distribution of health care resources and mitigating the risk of out-of-pocket (OOP) catastrophic healthcare expenditures (CHE) are the major objectives of the health system of a country. This study aims to measure equity in OOP payments for healthcare and the incidence of CHE among Iranian households over time. Methods This retrospective cross-sectional study utilized data extracted from the household income and expenditure survey (HIES) of Iran, collected by the Statistical Center of Iran. The analysis included a total of 174,341 households’ five yearly data of 6 years starting from 1991 to 2017. Kakwani progressivity index (KPI) was used to measure the equity in OOP payment for each year and examine the households’ incidence of CHE at 20%, 30%, and 40% of their capacities to pay (CTP). The trend series regression analysis was used to examine the trend in the KPI and the incidence of the CHE over time. Results The findings indicated that the households’ expenditure on health out of their monthly budgets for the years 1991 and 2017 were 2.1% and 10.1%, respectively. The KPI for the OOP payment was negative for all 6-year observations (1991 = − 0.680; 1996 = − 0.608; 2001 = − 0.554; 2006 = − 0.265; 2011 = − 0.225, and 2017 = − 0.207), indicating that the OOP payments for healthcare are regressive and more concentrated among the socioeconomically disadvantaged households. There was a statistically significant (p = 0.003) increase in the KPI (i.e., decline in the regressivity) over time. The incidence of the CHE (1.12, 1.93, and 3.71%) in 1991 at the CTP levels of 20%, 30%, and 40% was lower than the incidence at the corresponding levels of CTP (5.26, 10.88, and 22.16) in 2017. The findings of the time-series regression indicated a statistically significant (p < 0.05) increase in the incidence of the CHE at the 20%, 30%, and 40% levels of the households’ CTP. Conclusions The current study demonstrated that OOP payment as a source of healthcare funding in Iran is inequitable. While the use of interventions such as the prepaid and publicly funded programs may contribute to the reduction of CHE and improvement of equity in healthcare financing, further inequality analyses in the incidence of the CHE among households and its main determinants can contribute to evidence-informed planning to reduce the CHE in the context.

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Section: Discussionsupporting

confidence: 94%

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Rezaei

Woldemichael

Ebrahimi

et al. 2020

J. Egypt. Public. Health. Assoc.

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“…This is the case especially in the upper middle-income country such as Turkey (Yardim, Cilingiroglu, & Yardim, 2013), Iran (Rezapour et al, 2015) and China (Chen, Zhao, & Si, 2014) and some lower middle-income countries such as the Philippines (O'donnell et al, 2008), where OOP payments are paid according to population's ATP. However, some lower middle-income countries with big populations such as India (Chowdhury, Gupta, Trivedi, & Prinja, 2018) and Bangladesh (Molla & Chi, 2017), have a regressive OOP payments where the lower income populations, particularly in rural areas spent high proportion of OOP payments due to lack of access to public health care and lack of health protection scheme for the poor (Mondal, 2013), thus exposing the poorer population to risk of financial catastrophe and poverty.…”

Section: Progressivity Of Out-of-pocket Payments For Health Care: Intmentioning

confidence: 99%

Assesing Progressivity of Out-of-Pocket Expenditures for Health Care: Evidence From Households in Malaysia

M.A.B.¹,

Juni

Rosliza³

2019

IJPHCS

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Background: Out-of-pocket (OOP) payments is a principal means of financing health care throughout both developed and developing countries. Over-reliance on OOP payments may pose an undesirable effect from an equity perspective, where equity in financing is an important policy objective of the health care system. Objectives:To assess the progressivity of OOP payments for health care among Malaysian households.Methods: This paper used cross-sectional nationally representative data derived from the Malaysian Household Expenditure Survey (HES) 2014/15, which comprised of 14,473 households. Progressivity measures deviation from proportionality in the relation between OOP payments and ability to pay (ATP). This paper combined evidence from proportion approach, graphical measures (concentration curve) and summary indices (Gini coefficient, concentration index and Kakwani index) to demonstrate the progressivity of OOP health payments among Malaysian households.Result: More than two-third (77%) of Malaysian households surveyed reported to have made OOP health payments. The average shares of OOP payments from household consumption was 1.65% and was increasing across the household consumption quintiles. The OOP payments distribution was progressive demonstrated by all three approaches. The household consumption and burden of OOP payments was concentrated among the richer populations, with positive Gini coefficient and concentration index. The Kakwani index of OOP payments was 0.0910, indicates mildly progressive OOP payments in Malaysia. Conclusion:The OOP health payments in Malaysia has a progressive distribution. However, reducing progressivity trend should be monitored by the policymakers, and to decide further strategies on policy improvements pertaining to the country's health financing.

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“…Cost is one of the key barriers to adopting new interventions in the existing programs in low- and middle-income countries, and cost parameters are often estimated through recall [ 26 - 28 ]. The proposed research will capture the direct cost of the intervention based on actual activities involving the intervention in real time and estimate all possible realistic costs that would be incurred by both the schools (provider cost) and the participating families (out of pocket cost) due to integrating the proposed combined intervention.…”

Section: Introductionmentioning

confidence: 99%

Implementing a Mental Health Care Program and Home-Based Training for Mothers of Children With Autism Spectrum Disorder in an Urban Population in Bangladesh: Protocol for a Feasibility Assessment Study

Naheed¹,

Koly²,

Ahmed³

et al. 2017

JMIR Res Protoc

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BackgroundMothers of children with autism spectrum disorder (ASD) have reported a higher level of depression than mothers of children with other neurodevelopmental disorders in both developed and developing countries. Mothers are the lifetime caregivers of children with ASD, and a high burden of depression can negatively impact their ability to provide care. However, access to mental health services in primary care is limited, given the scarcity of qualified providers in Bangladesh.ObjectiveWe aim to pilot the feasibility of integrating mental health services for the mothers of children with ASD attending schools offering ASD care and improve skills of mothers for child care through a home-based training program.MethodsThe study will be conducted in two selected schools in Dhaka in Bangladesh that have been offering services for ASD for more than 10 years. A female psychologist will be deployed at the schools to offer nonpharmacological services for all mothers having a depressive episode. Referral for pharmacological treatment will be made at the discretion of supervising psychiatrists. An ASD special educator will provide training to the mothers for enhancing their child care skills at home on a monthly basis. The proposed intervention package will be implemented over a period of 4-6 months, and the feasibility of the intervention will be assessed through a pre- and postintervention evaluation by obtaining the perspectives of various stakeholders involved in the implementation of mental health services and maternal training. The primary outcome will include assessment of acceptability, adaptability, demand, practicality, implementation, and integration of the package intervention in the school settings. The secondary outcomes will include assessment of: 1) the prevalence of maternal depression; 2) children’s behavioral, social, and communication skills; and 3) the intervention participation costs incurred by institutions and families.ResultsBetween February and March 2017, 188 mothers of children with ASD were screened for depression following a written informed consent. Based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the Structured Clinical Interview for the DSM-IV (SCID-1) was administered to 66 mothers. In-depth interviews were conducted with 10 mothers and 8 various stakeholders. Between January-June 2017, the team finalized a draft psychosocial counseling module and a maternal training module. Between April-May 2017, mental health services were provided by psychologists to 41 mothers who attended the counseling centers at each school. Three special educators have been trained in June 2017 to initiate training of the participating mothers.ConclusionsThis is the first study of a mental health intervention for mothers of children with ASD to reduce their burden of depression and improve the outcomes of their children. The findings will inform the provision of services for children with ASD and their mothers in Bangladesh and similar settings.

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Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing

Cited by 39 publications

References 27 publications

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Assesing Progressivity of Out-of-Pocket Expenditures for Health Care: Evidence From Households in Malaysia

Implementing a Mental Health Care Program and Home-Based Training for Mothers of Children With Autism Spectrum Disorder in an Urban Population in Bangladesh: Protocol for a Feasibility Assessment Study

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