Health spending: people dig deeper in their pockets

Bangladesh’s direct health spending has continued to rise, leaving a large population with catastrophic medical bills, according to a recent Ministry of Health study.

Between 2015 and 2020, the OOP – which corresponds to the treatment expenses borne directly by a patient when neither public nor private insurance covers the total cost of the health good or service – rose from 67% to 68.5 %, according to the study.

This is the highest among the Saar countries, according to the technical study conducted by the Health Economics Unit (HEU) of the Ministry of Health to lower the OOP in the country. The results of the study were shared yesterday at an event titled “Ways to Reduce OOP Household Spending.”

Thanks to the increase in OOP, 16.4% of households avoid getting medical help even when needed, 24.4% of families (at an income level of 10%) are faced with catastrophic health bills and 4.5% of the population fall into poverty every year.

About 64 percent of OOP’s spending goes on drugs, compared to 28 percent in India.

There are two reasons for excessive drug spending: irrational prescribing and aggressive marketing, said Dr. Nurul Amin, director of research at HEU, in his presentation at the event.

Up to 60 percent of patients take drugs through self-medication and over-prescription from informal providers such as drug vendors and charlatans, while 25 percent of patients are prescribed expensive unlisted drugs.

About 58 percent of employees at pharmaceutical companies are engaged in marketing and distribution, according to the study. For example, in 2010, 27% of pharmaceutical companies’ revenues were spent on marketing.

To reduce the cost of drugs, the researchers recommended reviewing and expanding the list of emergency drugs and following the treatment protocol by doctors.

Hospital and outpatient services account for 12 percent and 11 percent of OOP expenditure, respectively.

According to the 2012-2032 Health Financing Strategy, the goal is to halve OOP spending to 32% by 2032.

But it’s increasing, which means Bangladesh’s goal of universal health coverage (UHC) by 2032 is unlikely to be met.

Protection against financial risks to people is one of the three aspects of UHC and the country is getting worse by the day in this regard. It has done well in terms of population coverage, service coverage.

One of the main causes of the increase in OOPs is excessive diagnostic testing, Health Minister Zahid Maleque said at the event.

Diagnosis of diseases accounts for 8 percent of OOP expenses.

“We are working to reduce the cost of diagnosis. I urge private health service providers to help in this regard,” he added.

Patients are forced to seek the services of diagnostic centers and private hospitals due to inadequate primary health care systems in both rural and urban areas.

Statistics show that only 3% of patients receive drugs from public hospitals while only 14.9% of tests are done there, Amin said.

To eradicate poverty, there is no alternative but to tackle the factors underlying a high OOP, he told the Daily Star.

To reduce OOP expenses, the researchers recommended coordination between community clinics and health complexes in Upazila by introducing e-health services, ensuring the efficiency of public health facilities, and introducing a system of healthcare. social health insurance.

They also recommended the introduction of an accreditation system for private health facilities to control health costs and standards and the mandatory use of generic names in prescriptions to discourage drug manufacturers from aggressive marketing. .