Exploring the impact of surging medical bills in Bangladesh.
Bangladeshis are now putting off getting medical care unless it becomes an absolute emergency. This is due to rising living costs, fueled by inflation cutting into overall consumer expenditure, which includes paying for healthcare. According to health service providers, there has been a decline in outpatients receiving routine checkups, pathology tests, and other diagnostics in private hospitals. How many people neglected their health care or skipped routine checks to control rising family expenses is not yet known from any official survey or data.
Government statistics show that in July, inflation increased to 7.48%, up from 5.36% in the same month the previous year. Another study released by the government concluded that per capita healthcare spending in Bangladesh increased by almost 60%, from BDT 2,862 to BDT 4,578. Dhaka had the largest yearly per capita expenditure in 2020 at BDT 7,039 according to a report created by the health economics division of the Ministry of Health and Family Welfare. According to the sixth Bangladesh National Health Accounts report, the Mymensingh division had the lowest health expenditures, at BDT 2,060.
As per the research, Bangladeshis spent a total of BDT 77,734 crore on healthcare in 2020, up from BDT 58,442 crore in 2015. According to the survey, people paid 69% of the cost out of their own pockets in 2020, an increase from their out-of-pocket health spending compared to five years ago. Out-of-pocket costs were BDT 29,985 crore in 2015 and BDT 53,274 crore in 2020. The study found that people spend 64.6% of their income on medications, 11.7% on diagnostics, and 10% on hospital expenses. Health rights advocates claimed that in order to stop health expenditures from rising, prescription prices must be controlled and unneeded testing must be discontinued.
Professor Quazi Quamruzzaman, the chairman of the Dhaka Community Hospital Trust, puts the blame on the healthcare system for high expenditures and high out-of-pocket charges. According to Professor Quamruzzaman, doctors frequently order pointless tests and crisis-inducing medications. If doctors allowed patients more time and space to consult with them, they could treat 85% of patients without writing a prescription for any medication, and 95% of patients would recover without needing to undertake any tests. He said, “We should focus on doctors to change the healthcare system first.”
Major General Mohammad Yousuf, the Director General of the Directorate General of Drug Administration, claimed that pharmaceutical corporations were pressuring them to raise drug prices once more due to rising medical costs. Health Secretary Md. Anwar Hossain Howlader claimed that pharmaceutical companies’ unethical marketing strategies boosted prescription prices because they provided doctors with refrigerators, televisions, money, and trips abroad, even paying for their Umrah in exchange for prescribing their medications. He continued by saying that while businesses spend a lot of money on packaging and raising prices, doctors frequently recommend pointless testing.
The Health Care Financing Strategy 2012-32 was created by the authorities with the goal of bringing down out-of-pocket medical expenses to 32% by 2032. But rather than declining, the percentage rose to 67% in 2015 and has continued to rise in subsequent years.
Medical expenses could be slashed in half, according to Ahmedul Kabir, acting Director General of the Directorate General of Health Services. Md Sayedur Rahman, a professor of pharmacology at Bangabandhu Sheikh Mujib Medical University, thinks that the government can lower out-of-pocket medical expenses if drug costs are controlled. He advised that after purchasing them from businesses at a fair price, the government provide 300 vital types of medications free of charge to the populace. He also added that when common medications are free, businesses will abstain from aggressive marketing and doctors will refrain from prescribing needless pills for commission. “If the government procures drugs, it will ensure quality as well as a competitive price,” he stated. Professor Rahman explained that if the government buys pharmaceuticals for BDT 6,000 crore, it will save citizens BDT 20,000 crore.
In order for the industry to provide essential medicines for the general populace, he also urged that the government boost the capacity of the state-owned Essential Drugs Company Limited.
Syed Abdul Hamid, a professor at Dhaka University’s Institute of Health Economics, said that the government might adjust the production formula, which would also assist in regulating drug pricing. According to health minister Zahid Maleque, a lack of maintenance over the years has resulted in numerous buildings and pieces of equipment becoming destroyed, which increased the expense of healthcare. He claimed that wealthy people spent a considerable portion of their own money, while the poor only spent 5% to 8%. According to the sixth Bangladesh National Health Accounts, Bangladeshis have been footing more than two-thirds of the bill for medical care.
The most recent report created by the Health Economics Unit of the health ministry states that the country’s percentage of out-of-pocket health expenditure was 56% in 1997, the year the study was originally issued but increased to over 69% in 2020. The Health Economics Unit found that the country’s out-of-pocket spending rate was quite high when viewed from a global viewpoint. The cost of vaccines and other expenses incurred by the government to combat the COVID-19 epidemic were not included in the report. Bangladeshis footed 62% of the bill for all medical expenses in 2012. The Health Care Financing Strategy 2012-32 was created by the authorities with the goal of bringing down out-of-pocket medical expenses to 32% by 2032. But rather than declining, the percentage rose to 67% in 2015 and has continued to rise in subsequent years.
The Health Economics Unit stated that every year 16% of patients choose not to receive critical healthcare services because out-of-pocket costs are continuing to climb. According to the Global Spending on Health, more households face catastrophic spending when a healthcare system relies heavily on out-of-pocket payment to finance its services.
Dr. Subrata Paul, the focal point for Bangladesh’s National Health Accounts Cell, stated, “In 2020, 68.5% of the country’s total health expenditure was paid out-of-pocket by treatment seekers, while the development aid agencies paid 5%.” Public sector spending made up 22.8% of all health spending in 2015, according to Bangladesh National Health (NHA), and it was expected to rise to 23.1% by 2020. The NHA has not yet given an account of current percentages.
According to the Health Economics Unit, patients spent a staggering BDT 34,400 crore, or 64.6% of their health care costs, on pharmaceuticals. BDT 7,200 crore, or 13.4%, was spent by patients on ambulatory medical service providers like general practitioners, dentists, and other healthcare professionals. In addition, households spent BDT 6,240 crore, or 11.7%, of their out-of-pocket money at medical and diagnostic facilities. the percentage of out-of-pocket spending on medical and diagnostic laboratories has risen in the last 20 years from 3.8% in 1997 to 11.7% in 2020.
The richest individuals spend BDT 1,714 per person, compared to the lowest individuals’ BDT 200. According to Dr. Subrata Paul, a comparison of per capita health spending within the same region or group reveals that the wealthiest households spend five times more than the lowest.
The Health Economics Unit stated that every year 16% of patients choose not to receive critical healthcare services because out-of-pocket costs are continuing to climb. According to the Global Spending on Health, more households face catastrophic spending when a healthcare system relies heavily on out-of-pocket payment to finance its services. Out-of-pocket spending as a percentage of total household consumption that exceeds 10% (lower threshold) or 25% (upper threshold) is deemed catastrophic under the Sustainable Development Goals (SDG) monitoring framework.
In the context of Bangladesh, the relentless surge in medical expenses has become a pressing issue, exerting immense economic pressure on individuals and the nation as a whole. The soaring costs of healthcare services, including consultations, diagnostic tests, medications, and hospital stays, have created a financial crisis for countless families. With a significant portion of the population living below the poverty line and lacking access to comprehensive health insurance, the burden of medical expenses has become particularly severe. As a result, households are forced to deplete their savings, sell assets, or accumulate substantial debts to cover these costs. The repercussions extend beyond individual financial hardships, straining the overall economy and hindering progress in key sectors. Urgent measures are required to address this escalating crisis and ensure equitable access to affordable healthcare for all Bangladeshis.
Furthermore, the burden of soaring medical expenses disproportionately affects vulnerable segments of the population, including low-income individuals, marginalised communities, and those living in rural areas. These groups already face barriers to accessing quality healthcare, and the escalating costs only widen the healthcare gap, perpetuating inequalities in society.
If left unaddressed, the financial strain caused by skyrocketing medical expenses could have far-reaching consequences for Bangladesh’s development efforts. It threatens to impede progress in areas such as education, infrastructure, and poverty alleviation, as limited resources are diverted towards healthcare expenditures.
