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    Benefit incidence analysis of healthcare in Bangladesh - equity matters for universal health coverage

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    Date
    2017
    Publisher
    © 2017 Oxford University Press
    Author
    Khan, Jahangir Am
    Ahmed, Sayem
    MacLennan, Mary E.
    Sarker, Abdur Razzaque
    Sultana, Marufa
    Rahman, Hafizur E.M.R.
    Metadata
    Show full item record
    URI
    http://hdl.handle.net/10361/9686
    Citation
    Khan, J. A. M., Ahmed, S., MacLennan, M., Sarker, A. R., Sultana, M., & Rahman, H. (2017). Benefit incidence analysis of healthcare in bangladesh - equity matters for universal health coverage. Health Policy and Planning, 32(3), 359-365. 10.1093/heapol/czw131
    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.
    Keywords
    Concentration indices; Decomposition; Universal health coverage; Health insurance
     
    Description
    This article was published in the Health Policy and Planning [© The Author 2016.] and the definitive version is available at: http://doi.org/10.1093/heapol/czw131 The Journal's website is at: https://academic.oup.com/heapol/article/32/3/359/2907862
    Publisher Link
    https://academic.oup.com/heapol/article/32/3/359/2907862
    DOI
    http://doi.org/10.1093/heapol/czw131
    Department
    James P Grant School of Public Health, BRAC University
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