Reports from the Health Economics Unit of the Directorate General of Health Services under the Ministry of Health & Family Welfare of Bangladesh show that out-of-pocket health expenditure was 56 per cent in 1997 and increased to 62 per cent in 2012. Around 67 per cent of all medical expenses in Bangladesh were covered out-of-pocket by the population in 2016. The goal of the "Health Care Financing Strategy 2012-32" is to bring down the share of out-of-pocket medical expenses to 32 per cent by 2032. However, the percentage continued to rise in the following years and rose to around 69 per cent in 2020. This very high share of out-of-pocket health expenditure in Bangladesh has been the subject of lengthy deliberations among public health experts, policymakers, and healthcare service professionals.
According to the Health Economics Unit reports, pharmaceuticals accounted for 64.6 per cent of patients' total health expenses, while ambulatory medical service providers, such as general practitioners, dentists, and other medical professionals, accounted for 13.4 per cent. Additionally, these households also spent a noteworthy portion 11.7 per cent - of their out-of-pocket payment at the medical and diagnostic facilities as well as 10.15 per cent for receiving care at the hospitals.
The recent increase in the cost of necessities and the general economic downturn has made this dialogue on health spending more important. The population's health deteriorates when people put off getting medical attention. The first step is to receive timely and adequate care; failing to do so will cause the health condition to become complicated and more costly over time.
The term "out-of-pocket health expenses" describes the costs that people themselves bear for medical services, treatments, and prescription drugs that are not reimbursed by the government, private insurance, or other third parties. Non-prescription drugs, medical supplies (things like bandages, crutches, or other medical supplies that may not be fully covered by the hospital or provider), and numerous associated services (alternative treatments, travel, meals) can all be included in these expenses.
Public health programme evaluations and economic burdens are being reported in Bangladesh and elsewhere more frequently, and these data are used to guide funding and programme selection. However, the non-medical costs that people incur as a result of a health condition are frequently left out of published economic burden assessments and evaluations that report out-of-pocket health costs. For instance, while seeking healthcare, patients and those who accompany them may lose money from employment or business. Non-wage losses include time lost by the patient from their family and friends supporting them at home and in the community. There is a reduction in quality of life as well. By merely shifting the costs to the patient and family, it is possible to conclude that a public health intervention is cost-effective or cost-beneficial.
There are three types of health expenses related to a disease or illness: direct medical, direct non-medical and indirect costs. The term "direct medical costs" refers to expenses related to the use of healthcare resources. Direct medical costs comprise costs related to emergency care, inpatient hospitalisation, and outpatient healthcare (health providers), as well as other relevant costs like doctor visits, prescription drugs, and lab and diagnostic test costs. The unit cost for each level of intervention, including hospitalisation, emergency care, and other healthcare provider care, is used to compute the utilisation of healthcare resources for direct medical costs. Transportation-related expenses, such as those incurred for traveling to and from medical facilities (such as doctor visits, emergency room visits, or hospital stays), are classified as direct non-medical costs.
Indirect costs include lost work productivity and loss of lifetime productivity of patients, family or caregivers. Healthy adult people provide a lot of social services and society loses when these free services are lost. Leisure time also has value and should be monetised. For example, for many workers, instead of staying with family, they could simply work and earn one and half times more than their regular hourly salary.
Transportation expenses are defined as the expenses related to the kilometers traveled to and from the hospital, pharmacy, and healthcare provider. Meals and lodging costs for the caregivers are additional expenses. Caregiver expenses also refer to the costs incurred when taking care of a child or elderly during a medical visit. The meals eaten away from home are an expense. The expenses related to caregivers like parents and spouses missing work or productivity because of patient care are known as indirect costs. Expenses related to the number of lost workdays and hours for patients and caregivers are referred to as lost worktime expenses.
An in-depth analysis of all expenses incurred by the healthcare system, the patient, or the society is necessary to comprehend and document the true cost of illness. Up until now, reports on Bangladesh's health burden have been seriously underestimating the real burden. Despite the complexity of the calculations, the rise in the prevalence of non-communicable diseases in the country has made the identification, listing, cataloging, quantification, and estimation of all costs more crucial.
When calculating programme benefits, governments and other organisations that set compensation policies for sick or injured people should take non-wage losses into account. Many public health prevention programmes will likely have a more favourable cost-benefit ratio when non-wage losses are taken into account. This will increase the social case for funding these programmes.
Hasnat M. Alamgir, PhD is Professor, Southeast University, Bangladesh.
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