Benefit Incidence Analysis of Healthcare in Bangladesh – Equity Matters for Universal Health Coverage

Khan, Jahangir ORCID: https://orcid.org/0000-0002-6151-764X, Ahmed, Sayem, MacLennan, Mary, Razzaque Sarker, Abdur, Sultana, Marufa and Rahman, Hafizur (2017) 'Benefit Incidence Analysis of Healthcare in Bangladesh – Equity Matters for Universal Health Coverage'. Health Policy and Planning, Vol 32, Issue 3, pp. 359-365.

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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 analyzed (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 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 favored 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.

Item Type:	Article
Subjects:	W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Administration and Organization > WA 540 National and state health administration
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1093/heapol/czw131
Depositing User:	Julie Franco
Date Deposited:	12 Sep 2016 14:28
Last Modified:	06 Sep 2019 11:09
URI:	https://archive.lstmed.ac.uk/id/eprint/6107

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