Rising healthcare cost beyond the means of many

Even though Bangladesh’s constitution recognises improving people’s nutritional level and public health as one of the primary duties of the state, the truth is that after 51 years of independence, the country hasn’t been able to ensure healthcare for all citizens.

Many are finding themselves unable to get treatment due to lack of money while many others are falling victim to wrong and maltreatment.

A recent report by the Health and Family Welfare Ministry reveals that per capita healthcare expenditure in Bangladesh rose by nearly 60 per cent from Tk 2,862 in 2015 to Tk 4,578 in 2020.

The annual per capita expenditure in Dhaka was Tk 7,039 in 2020, the highest among all eight divisions in the country. The lowest health expenses of Tk 2,060 were in the Mymensingh division. The total health expenditure of Bangladeshis in 2020 stood at Tk 77,734 crore, up from Tk 58,442 crore in 2015.

People spent 69 per cent of the cost out of their own pockets in 2020, up from their out-of-pocket health expenditure of 67 per cent five years earlier. In 2020, out-of-pocket expenditure was Tk 53,274 crore, while in 2015 it was Tk 29,985 crore. People spend 64.6 per cent on medicine, 11.7 per cent on diagnostics, and 10 per cent on hospital bills.

However, the number of people who have become destitute seeking healthcare in Bangladesh isn’t that low either. What’s even more worrying is that people stop seeking medical care when the cost of treatment is high.

The per capita income of people has increased, but the cost of living has increased manifolds compared to the rate of income going up. There are even examples of many becoming completely broke in meeting the medical expenses, especially. The rich ones of the society can afford to get treatment abroad or in reputed private hospitals of the country by spending extra money, they even do so.

But the overflowing government hospitals with almost no room available are the only hope for the poor and lower middle class people. It’s even more difficult to access healthcare at the government hospitals and upazila health complexes, outside of the big cities. There is no required number of physicians, nurses and technicians present in many upazila health complexes.

Then again, examples of people losing everything and being cheated while seeking medical care at private hospitals and clinics are not so low either. Even after the flaws of Bangladesh’s health care sector appeared loud and clear during the Corona period, no news of any effective measures being taken in this sector can be found.

Health experts have emphasised on increasing government allocation to the health sector as well as on improving the manpower and infrastructure to achieve universal health coverage. Currently, about 6 per cent of the national budget is allocated in the health sector.

According to experts, this allocation should be doubled to 12 per cent. Because spending on health is also a big investment for the future.

So, in addition to increasing the allocation, there has to be strong monitoring on where and how that allocation is being spent. The matter of bringing all the people of the country under the coverage of health insurance also has to be seriously considered.

Authorities concerned should revise and expand the list of emergency medicines and follow the treatment protocols prescribed by physicians, as well as reduce the diagnosis costs to bring down our overall healthcare costs. In addition, the aggressive marketing strategies by pharmaceutical companies have to be stopped. It should be made mandatory for our physicians to write down the generic names of medicines in their prescriptions, instead of promoting the medicines of any particular company, which would help reduce competition among pharmaceutical companies.