Jahangir A M Khan1,2,3,4, Sayem Ahmed2,3,4, Mary MacLennan5, Abdur Razzaque Sarker1,6, Marufa Sultana2, Hafizur Rahman7. 1. Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK. 2. Health Economics and Financing Research Group, Centre for Equity and Health Systems, icddr,b, Bangladesh. 3. Centre of Excellence for Universal health Coverage, icddr,b and James P Grant School of Public health, BRAC University, Bangladesh. 4. Health Economics Unit, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden. 5. London School of Economics, London, United Kingdom. 6. University of Strathclyde, Glasgow, Scotland, UK. 7. Health Economics Unit, Ministry of Health and Family Welfare, Bangladesh.
Abstract
BACKGROUND: Equity in access to and utilization of healthcare is an important goal for any health system and an essential prerequisite for achieving Universal Health Coverage for any country. OBJECTIVES: This study investigated the extent to which health benefits are distributed across socioeconomic groups; and how different types of providers contribute to inequity in health benefits of Bangladesh. METHODOLOGY: The distribution of health benefits across socioeconomic groups was estimated using concentration indices. Health benefits from three types of formal providers were analysed (public, private and NGO providers), separated into rural and urban populations. Decomposition of concentration indices into types of providers quantified the relative contribution of providers to the overall distribution of benefits across socioeconomic groups. Eventually, the distribution of benefits was compared to the distribution of healthcare need (proxied by 'self-reported illness and symptoms') across socioeconomic groups. Data from the latest Household Income and Expenditure Survey, 2010 and WHO-CHOICE were used. RESULTS: An overall pro-rich distribution of healthcare benefits was observed (CI = 0.229, t -value = 9.50). Healthcare benefits from private providers (CI = 0.237, t -value = 9.44) largely favoured the richer socioeconomic groups. Little evidence of inequity in benefits was found in public (CI = 0.044, t -value = 2.98) and NGO (CI = 0.095, t -value = 0.54) providers. Private providers contributed by 95.9% to overall inequity. The poorest socioeconomic group with 21.8% of the need for healthcare received only 12.7% of the benefits, while the richest group with 18.0% of the need accounted for 32.8% of the health benefits. CONCLUSION: Overall healthcare benefits in Bangladesh were pro-rich, particularly because of health benefits from private providers. Public providers were observed to contribute relatively slightly to inequity. The poorest (richest) people with largest (least) need for healthcare actually received lower (higher) benefits. When working to achieve Universal Health Coverage in Bangladesh, particular consideration should be given to ensuring that private sector care is more equitable.
BACKGROUND: Equity in access to and utilization of healthcare is an important goal for any health system and an essential prerequisite for achieving Universal Health Coverage for any country. OBJECTIVES: This study investigated the extent to which health benefits are distributed across socioeconomic groups; and how different types of providers contribute to inequity in health benefits of Bangladesh. METHODOLOGY: The distribution of health benefits across socioeconomic groups was estimated using concentration indices. Health benefits from three types of formal providers were analysed (public, private and NGO providers), separated into rural and urban populations. Decomposition of concentration indices into types of providers quantified the relative contribution of providers to the overall distribution of benefits across socioeconomic groups. Eventually, the distribution of benefits was compared to the distribution of healthcare need (proxied by 'self-reported illness and symptoms') across socioeconomic groups. Data from the latest Household Income and Expenditure Survey, 2010 and WHO-CHOICE were used. RESULTS: An overall pro-rich distribution of healthcare benefits was observed (CI = 0.229, t -value = 9.50). Healthcare benefits from private providers (CI = 0.237, t -value = 9.44) largely favoured the richer socioeconomic groups. Little evidence of inequity in benefits was found in public (CI = 0.044, t -value = 2.98) and NGO (CI = 0.095, t -value = 0.54) providers. Private providers contributed by 95.9% to overall inequity. The poorest socioeconomic group with 21.8% of the need for healthcare received only 12.7% of the benefits, while the richest group with 18.0% of the need accounted for 32.8% of the health benefits. CONCLUSION: Overall healthcare benefits in Bangladesh were pro-rich, particularly because of health benefits from private providers. Public providers were observed to contribute relatively slightly to inequity. The poorest (richest) people with largest (least) need for healthcare actually received lower (higher) benefits. When working to achieve Universal Health Coverage in Bangladesh, particular consideration should be given to ensuring that private sector care is more equitable.
Authors: Jahangir A M Khan; Sayem Ahmed; Marufa Sultana; Abdur Razzaque Sarker; Sanchita Chakrovorty; Mohammad Hafizur Rahman; Ziaul Islam; Clas Rehnberg; Louis W Niessen Journal: Int Health Date: 2020-07-01 Impact factor: 2.473