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BMC Health Services Research

, 17:94

Utilization, expenditure, economics and financing systems


BackgroundPredictors of high out-of-pocket household healthcare expenditure are essential for creating effective health system finance policy. In Bangladesh, 63.3% of health expenditure is out-of-pocket and born by households. It is imperative to know what determines household health expenditure. This study aims to investigate the predicting factors of high out-of-pocket household healthcare expenditure targeting to put forward policy recommendations on equity in financial burden.

MethodsBangladesh household income and expenditure survey 2010 provides data for this study. Predictors of high out-of-pocket household healthcare expenditure were analyzed using multiple linear regressions. We have modeled non-linear relationship using logarithmic form of linear regression. Heteroscedasticity and multicollinearity were checked using Breusch-Pagan-Cook-Weishberg and VIF tests. Normality of the residuals was checked using Kernel density curve. We applied required adjustment for survey data, so that standard errors and parameters estimation are valid.

ResultsPresence of chronic disease and household income were found to be the most influential and statistically significant p < 0.001 predictors of high household healthcare expenditure. Households in rural areas spend 7% less than urban dwellers. The results show that a 100% increase in female members in a family leads to a 2% decrease in household health expenditure. Household income, health shocks in families, and family size are other statistically significant predictors of household healthcare expenditure. Proportion of elderly and under-five members in the family show some positive influence on health expenditure, though statistically nonsignificant.

ConclusionsThe findings call for emphasizing prevention of chronic diseases, as it is a strong predictor of household health expenditure. Innovative insurance scheme needs to be devised to prevent household from being impoverished due to health shocks in the family. Policy makers are urged to design an alternative source of healthcare financing in Bangladesh to minimize the burden of high OOP healthcare expenditure.

KeywordsPredictors of healthcare expenditure Out-of-pocket expenditure Health systems finance Health policy Household financial burden Chronic illness Rural-urban differentials AbbreviationsBBSBangladesh Bureau of Statistics

ESPEssential services package

GDPGross domestic product

HIESHousehold income and expenditure survey

OOPOut-of-pocket payment

PSUPrimary sampling unit

TKTaka Bangladesh currency

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Autor: Azaher Ali Molla - Chunhuei Chi - Alicia Lorena Núñez Mondaca


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