Bangladeshis sixth biggest private spenders on health alongside Indians: The Lancet

Bangladeshis are the sixth biggest out-of-pocket spenders on health in the world along with Indians, a new study by the British medical journal The Lancet suggests.

The study, released recently, identified health spending trends and country specific deviations for 184 nations from 1995 to 2014 to provide insight into what future health financing challenges are look like.

The findings show that, on average, economic development is associated with increases in health spending per person and decreases in the share of spending that is financed out-of-pocket (OOP).

Bangladeshis and Indians spend 65.6 percent from their own pocket while seeking healthcare. Azerbaijan, Cameroon, Nigeria, Sudan, and Tajikistan are the five countries where people have to pay more than Bangladeshis and Indians.

The World Health Organisation advocates strongly against out-of-pocket payments for health as this can cause households to incur catastrophic expenditures, which in turn can push them into poverty.

The need to pay out-of-pocket can also mean that households do not seek care when they need it. To address this, WHO suggests adequate amount of prepaid resources for health to ensure access to health services and for the pursuit of universal health coverage.

Director General for Health Services Abul Kalam Azad told bdnews24.com that they are aware of the fact that people have to pay more than the government in Bangladesh for health services.

“But we are increasing stakes in our own pursuit to attain universal health coverage by 2030,” he said. “This is the goal of the government as part of the SDG.”

He said as a first step, they will introduce ‘essential service package’ in the current health sector programme for five years.

“During the course of this journey we will see how to implement that in the next 10 years and how to stop direct payments at the point of sale,” he said.

The findings of the study expand the understanding of the health financing transition.

In 2014 health spending per capita across all countries was $1279.

This spending was concentrated in high-income countries, and ranged from $33 in Somalia to $9237 in the US, highlighting the tremendous variation in how much is spent on health around the world.

Disparate spending levels also exist within World Bank income groups. In 2014, health spending across low-income countries was $120 per capita, but range from $33 in Somalia to $347 in Uganda.

Spending per capita across lower-middle-income countries was $267, but ranged from $92 in Bangladesh to $791 in Tunisia, while spending per capita in upper-middle-income countries was $914, but ranged from $228 in Angola to $1980 in Maldives.

Finally, health spending per capita was $5221 in high-income countries, and ranged from $853 in Seychelles to $9237 in US.

The report highlights how total health spending per capita has changed between 1995 and 2014.

Upper-middle and lower-middle-income country groups have increased per capita health spending the fastest, with annualised growth rates of 5.9 percent and 5.0 percent, respectively.

Over the course of 20 years, this has led to a near tripling of health spending per capita in upper-middle-income countries, from $309 to $914 per capita.

Spending in low-income countries grew at 4.6 percent, while the slowest growth was observed in high-income countries, which grew collectively at 3.0 percent per year. In Bangladesh, the growth was 3.2 percent.

Missing middle concept

The report highlights three distinct health financing stages that emerge along the spectrum of economic development.

In the first stage, health financing is dominated by development assistance for health and OOP.

In the second stage, development assistance for health subsides, and the primary sources of health-care financing are OOP and domestic government spending.

Finally, the third stage includes countries with the highest GDP per capita, which tend to finance health care using government spending.

This research also points to countries that deviate from the trends, spending more or less than expected, based on their level of economic development.

The Lancet says at the nexus of economic development and health financing are concerns related to what some have called the “missing middle”.

“This missing middle concept, which has been debated, asserts that in the process of transitioning from low-income to middle-income status, countries receive less development assistance for health although they are not yet able to domestically raise sufficient government resources to replace the lost external resources.

“Identifying, understanding, and managing this potential is of crucial importance because more than 70 percent of the world’s poor live in middle-income-countries,” The Lancet commented.

A result of a premature transition from development assistance for health would be a reduction in prepaid, pooled resources, and an increase in out of pocket financing.

“Our estimates provide some evidence of this occurrence, because lower-middle-income countries finance more of their health spending OOP than any other income group,” The Lancet observed.