Distribution and determinants of out-of-pocket healthcare expenditures in Bangladesh

Rashidul Alam Mahumud, Abdur Razzaque Sarker, Marufa Sultana, Ziaul Islam, Jahangir Khan, Alec Morton

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Like many low and middle income countries, out-of-pocket payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burden of household. The objective of the study was to focus whether and to what extent socio-economic, demographic and behavioral factors of the population have impact on OOP expenditure in Bangladesh.
A total of 12,400 patients who spent for receiving any type of healthcare services were analyzed from Bangladesh Household Income and Expenditure Survey data, 2010. We employed a regression analysis for find out the factors influencing OOP health expenditure using ordinary least square method.
The mean total out-of-pocket healthcare expenditure was US$ 27.66; while cost of medicines (US$ 16.98) was the highest cost driver. In addition, the study identifies some significant factors influencing higher out-of-pocket health expenditure, namely, age, sex, marital status, place of residence, rich families. In contrary, unemployed and with no social financial safety were inversely associated.
Findings of the study can help the decision makers by stating the determinants of OOP, discussing the mechanisms driving them and thus underscoring the need to develop policy options for the building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. Parallel to government action, the development of other prudential and sustainable risk pooling mechanism and so may be most enthusiastic subscribers to community-based health insurance schemes.
Original languageEnglish
Pages (from-to)91-99
JournalJournal of Preventive Medicine and Public Health
Issue number2
Early online date7 Feb 2017
Publication statusPublished - Mar 2017


  • Bangladesh
  • household income
  • household expenditure
  • healthcare expenditure
  • out-of-pocket
  • socio-economic
  • demographic
  • behavioural factors
  • risk pooling mechanism
  • social financial safety
  • GDP per capita


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