Out-of-pocket healthcare spending must drop

Bangladesh needs to move beyond “business as usual” health sector allocations in the budget for FY23. Out-of-pocket expenditure by the people currently takes up 68 per cent of Bangladesh’s total spending in this sector, while the government covers only 23 per cent.

Experts say, under such circumstances, Bangladesh’s health sector allocations in the upcoming budget must be aimed at reducing the people’s out-of-pocket expenditure for availing healthcare.

They made the remarks at a pre-budget national dialogue, organised jointly by the Bangladesh Health Watch, Brac James P Grant School of Public Health, Brac University, and Unnayan Shamannay in the Daily Star’s Azimur Rahman Conference Hall on Monday.

Former governor of the central bank and President of Unnayan Shamannay Dr Atiur Rahman presented a keynote developed based on data from the government’s Finance Division and findings from a recent field survey.

He pointed out that by tripling the allocations for the medical and surgical supply sub-sector of the health budget and by filling up all the vacancies at the Upazila health complexes, union health sub-centers, and community clinics, the share of the out-of-pocket costs can be brought down from 68 per cent to 51 per cent.

However, to ensure access to quality healthcare, the policymakers must go beyond just increasing allocations, and aim to revamp the entire health sector, the former governor said.

According to the keynote, of the overall healthcare costs, citizens pay 68 per cent, government pays 23 per cent, development partners pay 5 per cent, non-government organisations pay 2 per cent, and private sector pays 2 per cent.

A citizen spends around 67 per cent of their healthcare expenditure on medicines and other perishable medical products, 13 per cent on outpatient curative services, 8 per cent on inpatient curative services, 7 per cent of laboratory services and 5 per cent on imaging services.

The keynote also reveals that 12 per cent of citizens do not seek out professional medical services after suffering illness or accidents. This figure is 23 per cent in metropolises, 17 per cent in remote areas. 

Lawmaker Habibe Millat, , in his remarks, emphasised the health sector’s needs in the medium to long-term national planning documents such as the five-year plans of the government.

Meanwhile, MP Rumin Farhana said, “The neighboring Bhutan has universal healthcare, and India is experimenting with different health insurance schemes for the lower-income groups. Bangladesh can learn from these experiences and plan a way to initiate universal healthcare.”

MP Shamim Haider Patwary pointed out that the government alone cannot ensure quality healthcare for all the people in the country, rather it should go for building partnerships with private sector healthcare providers.

Addressing the discussion, other speakers raised issues such as prioritising primary healthcare, quality control of the private healthcare providers, gender-responsiveness of the health budget, and sexual reproductive healthcare.