The Journal of Health, Population and Nutrition
Vol. 36, No. 1, 2017, pp. 1-9
Bioline Code: hn17028
Full paper language: English
Document type: Research Article
Document available free of charge
The Journal of Health, Population and Nutrition, Vol. 36, No. 1, 2017, pp. 1-9
© Copyright 2017 - The Author(s)
Out-of-pocket expenditure for seeking health care for sick children younger than 5 years of age in Bangladesh: findings from cross-sectional surveys, 2009 and 2012|
Tahsina, Tazeen; Ali, Nazia Binte; Hoque, D.M. Emdadul; Huda, Tanvir M.; Salam, Shumona Sharmin; Hasan, Mohammad Mehedi; Hossain, Md Altaf; Matin, Ziaul; Kuppen, Lianne; Garnett, Sarah P. & Arifeen, Shams El
Background: Bangladesh has committed to universal health coverage, and options to decrease household out-of-pocket
expenditure (OPE) are being explored. Understanding the determinants of OPE is an essential step. This study
aimed to estimate and identify determinants of OPE in seeking health care for sick under-five children.
Methods: Cross-sectional data was collected by structured questionnaire in 2009 (n = 7362) and 2012 (n = 6896) from
mothers of the under-five children. OPE included consultation fees and costs of medicine, diagnostic tests,
hospital admission, transport, accommodation, and food. Expenditure is expressed in US dollars and adjusted
for inflation. Linear regression was used for ascertaining the determinants of OPE.
Results: Between 2009 and 2012, the median OPE for seeking care for a sick under-five child increased by ~ 50%, from
USD 0.82 (interquartile range 0.39–1.49) to USD 1.22 (0.63–2.36) per child/visit. Increases were observed in
every component OPE measured, except for consultation fees which decreased by 12%. Medicine contributed
the major portion of overall OPE. Higher overall OPE for care seeking was associated with a priority illness
(20% increase), care from trained providers (90% public/~ 2-fold private), residing in hilly/wet lands areas (20%)
, and for mothers with a secondary education (19%).
Conclusion: OPE is a major barrier to quality health care services and access to appropriate medicine is increasing in
rural Bangladesh. To support the goal of universal health care coverage, geographic imbalances as well as expanded
health financing options need to be explored.
Out-of-pocket expenditure; Childhood illnesses; Under-five children; Health care-seeking; Bangladesh
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