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

Jahangir A. M. Khan, Sayem Ahmed, Mary MacLennan, Abdur Razzaque Sarker, Marufa Sultana, Hafizur Rahman

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Equity in access to and utilization of healthcare is an important goal for any health system and an essential prerequisite for achieving Universal Health Coverage for any country.
Objectives: This study investigated the extent to which health benefits are distributed across socioeconomic groups; and how different types of providers contribute to inequity in health benefits of Bangladesh.
Methodology: The distribution of health benefits across socioeconomic groups was estimated using concentration indices. Health benefits from three types of formal providers were analysed (public, private and NGO providers), separated into rural and urban populations. Decomposition of concentration indices into types of providers quantified the relative contribution of providers to the overall distribution of benefits across socioeconomic groups. Eventually, the distribution of benefits was compared to the distribution of healthcare need (proxied by ‘self-reported illness and symptoms’) across socioeconomic groups. Data from the latest Household Income and Expenditure Survey, 2010 and WHO-CHOICE were used.
Results: An overall pro-rich distribution of healthcare benefits was observed (CI¼0.229, t-value¼9.50). Healthcare benefits from private providers (CI¼0.237, t-value¼9.44) largely favoured the richer socioeconomic groups. Little evidence of inequity in benefits was found in public (CI¼0.044, t-value¼2.98) and NGO (CI¼0.095, t-value¼0.54) providers. Private providers contributed by 95.9% to overall inequity. The poorest socioeconomic group with 21.8% of the need for healthcare received only 12.7% of the benefits, while the richest group with 18.0% of the need accounted for 32.8% of the health benefits.
Conclusion: Overall healthcare benefits in Bangladesh were pro-rich, particularly because of health benefits from private providers. Public providers were observed to contribute relatively slightly to inequity. The poorest (richest) people with largest (least) need for healthcare actually received lower (higher) benefits. When working to achieve Universal Health Coverage in Bangladesh, particular consideration should be given to ensuring that private sector care is more equitable.
Original languageEnglish
Pages (from-to)359–365
Number of pages7
JournalHealth Policy and Planning
Volume32
Issue number3
Early online date4 Oct 2016
DOIs
Publication statusPublished - 1 Apr 2017

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Universal Coverage
Bangladesh
Insurance Benefits
Delivery of Health Care
Incidence
Health
Urban Population
Private Sector
Rural Population
Health Expenditures

Keywords

  • equity in health benefits
  • universal health coverage
  • Bangladesh
  • concentration indices
  • decomposition
  • urban settings
  • rural settings
  • socioeconomic groups

Cite this

Khan, J. A. M., Ahmed, S., MacLennan, M., Sarker, A. R., Sultana, M., & Rahman, H. (2017). Benefit incidence analysis of healthcare in Bangladesh – equity matters for universal health coverage. Health Policy and Planning, 32(3), 359–365. https://doi.org/10.1093/heapol/czw131
Khan, Jahangir A. M. ; Ahmed, Sayem ; MacLennan, Mary ; Sarker, Abdur Razzaque ; Sultana, Marufa ; Rahman, Hafizur. / Benefit incidence analysis of healthcare in Bangladesh – equity matters for universal health coverage. In: Health Policy and Planning. 2017 ; Vol. 32, No. 3. pp. 359–365.
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Khan, JAM, Ahmed, S, MacLennan, M, Sarker, AR, Sultana, M & Rahman, H 2017, 'Benefit incidence analysis of healthcare in Bangladesh – equity matters for universal health coverage', Health Policy and Planning, vol. 32, no. 3, pp. 359–365. https://doi.org/10.1093/heapol/czw131

Benefit incidence analysis of healthcare in Bangladesh – equity matters for universal health coverage. / Khan, Jahangir A. M.; Ahmed, Sayem; MacLennan, Mary; Sarker, Abdur Razzaque; Sultana, Marufa; Rahman, Hafizur.

In: Health Policy and Planning, Vol. 32, No. 3, 01.04.2017, p. 359–365.

Research output: Contribution to journalArticle

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AU - Khan, Jahangir A. M.

AU - Ahmed, Sayem

AU - MacLennan, Mary

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AU - Sultana, Marufa

AU - Rahman, Hafizur

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N2 - Background: Equity in access to and utilization of healthcare is an important goal for any health system and an essential prerequisite for achieving Universal Health Coverage for any country.Objectives: This study investigated the extent to which health benefits are distributed across socioeconomic groups; and how different types of providers contribute to inequity in health benefits of Bangladesh.Methodology: The distribution of health benefits across socioeconomic groups was estimated using concentration indices. Health benefits from three types of formal providers were analysed (public, private and NGO providers), separated into rural and urban populations. Decomposition of concentration indices into types of providers quantified the relative contribution of providers to the overall distribution of benefits across socioeconomic groups. Eventually, the distribution of benefits was compared to the distribution of healthcare need (proxied by ‘self-reported illness and symptoms’) across socioeconomic groups. Data from the latest Household Income and Expenditure Survey, 2010 and WHO-CHOICE were used.Results: An overall pro-rich distribution of healthcare benefits was observed (CI¼0.229, t-value¼9.50). Healthcare benefits from private providers (CI¼0.237, t-value¼9.44) largely favoured the richer socioeconomic groups. Little evidence of inequity in benefits was found in public (CI¼0.044, t-value¼2.98) and NGO (CI¼0.095, t-value¼0.54) providers. Private providers contributed by 95.9% to overall inequity. The poorest socioeconomic group with 21.8% of the need for healthcare received only 12.7% of the benefits, while the richest group with 18.0% of the need accounted for 32.8% of the health benefits.Conclusion: Overall healthcare benefits in Bangladesh were pro-rich, particularly because of health benefits from private providers. Public providers were observed to contribute relatively slightly to inequity. The poorest (richest) people with largest (least) need for healthcare actually received lower (higher) benefits. When working to achieve Universal Health Coverage in Bangladesh, particular consideration should be given to ensuring that private sector care is more equitable.

AB - Background: Equity in access to and utilization of healthcare is an important goal for any health system and an essential prerequisite for achieving Universal Health Coverage for any country.Objectives: This study investigated the extent to which health benefits are distributed across socioeconomic groups; and how different types of providers contribute to inequity in health benefits of Bangladesh.Methodology: The distribution of health benefits across socioeconomic groups was estimated using concentration indices. Health benefits from three types of formal providers were analysed (public, private and NGO providers), separated into rural and urban populations. Decomposition of concentration indices into types of providers quantified the relative contribution of providers to the overall distribution of benefits across socioeconomic groups. Eventually, the distribution of benefits was compared to the distribution of healthcare need (proxied by ‘self-reported illness and symptoms’) across socioeconomic groups. Data from the latest Household Income and Expenditure Survey, 2010 and WHO-CHOICE were used.Results: An overall pro-rich distribution of healthcare benefits was observed (CI¼0.229, t-value¼9.50). Healthcare benefits from private providers (CI¼0.237, t-value¼9.44) largely favoured the richer socioeconomic groups. Little evidence of inequity in benefits was found in public (CI¼0.044, t-value¼2.98) and NGO (CI¼0.095, t-value¼0.54) providers. Private providers contributed by 95.9% to overall inequity. The poorest socioeconomic group with 21.8% of the need for healthcare received only 12.7% of the benefits, while the richest group with 18.0% of the need accounted for 32.8% of the health benefits.Conclusion: Overall healthcare benefits in Bangladesh were pro-rich, particularly because of health benefits from private providers. Public providers were observed to contribute relatively slightly to inequity. The poorest (richest) people with largest (least) need for healthcare actually received lower (higher) benefits. When working to achieve Universal Health Coverage in Bangladesh, particular consideration should be given to ensuring that private sector care is more equitable.

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KW - universal health coverage

KW - Bangladesh

KW - concentration indices

KW - decomposition

KW - urban settings

KW - rural settings

KW - socioeconomic groups

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