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Objective - The purpose of this study was to investigate the distribution of chronic illness and associated disability, out-of-pocket payment (OOPP), and other related factors using survey data from Bangladesh. Methods - This study analyzed Bangladesh Household Income and Expenditure Survey data that include socio-economic and demographic data, such as consumption, expenditures, and assets, along with information regarding chronic illness and disability. Multiple linear regression models were used to identify factors significantly associated with OOPP. Furthermore, a binary Logistic regression model was employed to assess the association of the explanatory variables with disability status. Results - A higher prevalence of chronic illness was found for those with chronic gastritis (18.70%), and 41.92% of the population had at least one side disability. The average OOPP healthcare expenditure for chronic illness was estimated to be US$7.59. Higher OOPP was found among the upper 2 wealth quintiles. Overall OOPP health expenditure was significantly higher among individuals with an associated disability (P < 0.001). The likelihood of having an associated disability was higher among those individuals with a lower education level (OR = 2.36, 95% CI: 1.95–4.06), those who not earning an income (OR = 2.85, 95% CI: 2.53–3.21), those who did not seek care (OR = 1.73, 95% CI: 1.57–1.90), those who sought care from a pharmacy (OR = 8.91, 95% CI: 7.38–10.74), and those in the lowest wealth quintile (OR = 7.21, 95% CI: 6.41–8.12). Conclusions - The high OOPP illustrates the necessity of financial risk protection for the population at low socio-economic status. Therefore, we recommend that the government strengthen the healthcare system with appropriate support directed to the rural and elderly populations.

Achieving Universal Health Coverage is among the core objectives of the health Sustainable Development Goals, and making healthcare affordable to everyone is fundamental to achieving Universal Health Coverage. ▸ Cooperative societies are autonomous groups of persons who voluntarily cooperate for their common economic interest, based on the values of self-help, self-responsibility, democracy and equality, equity and solidarity. ▸ There are 190 360 cooperatives in Bangladesh, and the total individual enrolees are 10 333 310 (with about 160 million people covered when spouses or dependents of enrolees are taken into account). Given this large pool, cooperative societies could be a platform to engage a large number of people regarding healthcare financing. ▸ Cooperative societies act as a risk management strategy for members, working on the basic principle of risk pooling during illness. This risk pooling mechanism can mitigate the consequences of dependence on out of pocket payments to finance healthcare, thereby facilitating the move towards Universal Health Coverage.

SummaryMany Bangladeshi women marry early, and many marry before the legal age of 18 years. This practice has been associated with a higher risk of health and medical morbidities, and also early pregnancy with higher pre- and postnatal complications. The aim of this study was to determine the prevalence, and factors associated with, child marriage among Bangladeshi women using multiple binary logistic regression analysis of data from the BDHS-2011. Further analysis on the trend of age at first marriage was performed with additional data sets from previous surveys. The mean and median of ages at first marriage of Bangladeshi women in 2011 were 15.69±2.97 and 15.00 years, respectively. A remarkably high percentage (78.2%) married before the age of 18; of these, 5.5% married at a very early age (before 13 years of age). Binary logistic regression analysis demonstrated that uneducated women were more likely to be married early (p<0.001) than those with secondary and higher education. Child marriage was especially pronounced among women with uneducated husbands, Muslims, those with poor economic backgrounds and those living in rural areas. Further analysis including data from previous BDHS surveys showed that child marriage among Bangladeshi women had a decreasing trend from 1993–94 to 2011. These results show that child marriage was very common in Bangladesh, and closely associated with low level of education and low economic status. The decreasing trend in child marriage indicates an improvement over the past two decades but more effort is needed to further reduce and eventually eliminate the practice.

Rawal, LB orcid:0000-0003-1106-0108 ; Life expectancy is one of the major key indicators of population health condition and economic development of a country. The main objective of this study was to find determine the impact of the life expectancy on changes of economic growth and health care expenditure, and also to find examine the sex difference trend of life expectancy according to the sex difference. Using We used multiple regression models are fitted to estimate the impact of the life expectancy on economic growth and health care expenditure and also to estimate elasticity of life expectancy on health care expenditure and economic growth. Results shows female life expectancy was more than male over the past 15 years. The higher Gross Domestic Product (GDP) per capita was seen in a longer life expectancy. i.e., one dollar increasing in GDP per capita will change in an average the life expectancy by 33 days, and also one unit increase in per person Health Expenditure Per Capita (HEPC) will increase the life expectancy in an average of 8 days in a year. one dollar increasing in GDP per capita by 33 days will also increase life expectancy, for Health Expenditure Per Capita (HEPC), by 8 days by one year on average. The higher proportion of total expenditure on health as a percentage of GDP and direct personal expenditure on health by household as a share of private expenditure on health results in also longer life span. The study has some policy implications for Bangladesh, we conclude that the increased life expectancy has direct impact on increase in per capita real income and higher expenditure on health., population planning and equity for health important for life expectancy. This study has policy implications for Bangladesh, in particular the needs for increased per capita real income and planning for future health and population policies/programs. Therefore, political stability, adequate and suitable social sector policies and government interventions are required to increase life expectancy and economic growth. There is also a need for involvement of health human force in macro and micro policy-makings and critically examine other determinant of health care expenditure.

Objectives As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

Objectives: Like many low and middle income countries, out-of-pocket payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burden of household. The objective of the study was to focus whether and to what extent socio-economic, demographic and behavioral factors of the population have impact on OOP expenditure in Bangladesh. Method: A total of 12,400 patients who spent for receiving any type of healthcare services were analyzed from Bangladesh Household Income and Expenditure Survey data, 2010. We employed a regression analysis for find out the factors influencing OOP health expenditure using ordinary least square method. Results: The mean total out-of-pocket healthcare expenditure was US$ 27.66; while cost of medicines (US$ 16.98) was the highest cost driver. In addition, the study identifies some significant factors influencing higher out-of-pocket health expenditure, namely, age, sex, marital status, place of residence, rich families. In contrary, unemployed and with no social financial safety were inversely associated. Conclusions: Findings of the study can help the decision makers by stating the determinants of OOP, discussing the mechanisms driving them and thus underscoring the need to develop policy options for the building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. Parallel to government action, the development of other prudential and sustainable risk pooling mechanism and so may be most enthusiastic subscribers to community-based health insurance schemes.