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

BACKGROUND: The relationship between payments towards healthcare and ability to pay is a measure of financial fairness. Analysis of progressivity is important from an equity perspective as well as for macroeconomic and political analysis of healthcare systems. Bangladesh health systems financing is...

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Autores principales: Molla, Azaher Ali, Chi, Chunhuei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586060/
https://www.ncbi.nlm.nih.gov/pubmed/28874198
http://dx.doi.org/10.1186/s12939-017-0654-3
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author Molla, Azaher Ali
Chi, Chunhuei
author_facet Molla, Azaher Ali
Chi, Chunhuei
author_sort Molla, Azaher Ali
collection PubMed
description BACKGROUND: The relationship between payments towards healthcare and ability to pay is a measure of financial fairness. Analysis of progressivity is important from an equity perspective as well as for macroeconomic and political analysis of healthcare systems. Bangladesh health systems financing is characterized by high out-of-pocket payments (63.3%), which is increasing. Hence, we aimed to see who pays what part of this high out-of-pocket expenditure. To our knowledge, this was the first progressivity analysis of health systems financing in Bangladesh. METHODS: We used data from Bangladesh Household Income and Expenditure Survey, 2010. This was a cross sectional and nationally representative sample of 12,240 households consisting of 55,580 individuals. For quantification of progressivity, we adopted the ‘ability-to-pay’ principle developed by O’Donnell, van Doorslaer, Wagstaff, and Lindelow (2008). We used the Kakwani index to measure the magnitude of progressivity. RESULTS: Health systems financing in Bangladesh is regressive. Inequality increases due to healthcare payments. The differences between the Gini coefficient and the Kakwani index for all sources of finance are negative, which indicates regressivity, and that financing is more concentrated among the poor. Income inequality increases due to high out-of-pocket payments. The increase in income inequality caused by out-of-pocket payments is 89% due to negative vertical effect and 11% due to horizontal inequity. CONCLUSIONS: Our findings add substantial evidence of health systems financing impact on inequitable financial burden of healthcare and income. The heavy reliance on out-of-pocket payments may affect household living standards. If the government and people of Bangladesh are concerned about equitable financing burden, our study suggests that Bangladesh needs to reform the health systems financing scheme.
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spelling pubmed-55860602017-09-06 Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing Molla, Azaher Ali Chi, Chunhuei Int J Equity Health Research BACKGROUND: The relationship between payments towards healthcare and ability to pay is a measure of financial fairness. Analysis of progressivity is important from an equity perspective as well as for macroeconomic and political analysis of healthcare systems. Bangladesh health systems financing is characterized by high out-of-pocket payments (63.3%), which is increasing. Hence, we aimed to see who pays what part of this high out-of-pocket expenditure. To our knowledge, this was the first progressivity analysis of health systems financing in Bangladesh. METHODS: We used data from Bangladesh Household Income and Expenditure Survey, 2010. This was a cross sectional and nationally representative sample of 12,240 households consisting of 55,580 individuals. For quantification of progressivity, we adopted the ‘ability-to-pay’ principle developed by O’Donnell, van Doorslaer, Wagstaff, and Lindelow (2008). We used the Kakwani index to measure the magnitude of progressivity. RESULTS: Health systems financing in Bangladesh is regressive. Inequality increases due to healthcare payments. The differences between the Gini coefficient and the Kakwani index for all sources of finance are negative, which indicates regressivity, and that financing is more concentrated among the poor. Income inequality increases due to high out-of-pocket payments. The increase in income inequality caused by out-of-pocket payments is 89% due to negative vertical effect and 11% due to horizontal inequity. CONCLUSIONS: Our findings add substantial evidence of health systems financing impact on inequitable financial burden of healthcare and income. The heavy reliance on out-of-pocket payments may affect household living standards. If the government and people of Bangladesh are concerned about equitable financing burden, our study suggests that Bangladesh needs to reform the health systems financing scheme. BioMed Central 2017-09-06 /pmc/articles/PMC5586060/ /pubmed/28874198 http://dx.doi.org/10.1186/s12939-017-0654-3 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Molla, Azaher Ali
Chi, Chunhuei
Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing
title Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing
title_full Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing
title_fullStr Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing
title_full_unstemmed Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing
title_short Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing
title_sort who pays for healthcare in bangladesh? an analysis of progressivity in health systems financing
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586060/
https://www.ncbi.nlm.nih.gov/pubmed/28874198
http://dx.doi.org/10.1186/s12939-017-0654-3
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