Publication: Pathways to Reduce Household Out-of-Pocket Expenditure
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2020-08
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2021-06-03
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Bangladesh allocates a much smaller share of the government budget to health than countries of similar income level. Reallocation is politically challenging but could offer the biggest potential source of fiscal space for health, larger than the space that economic growth can bring. How those additional resources are used, is also important to improve financial protection. Improving the readiness of the public health care network to provide quality care, particularly at primary health care level, could reduce the use of alternative providers, thereby reducing the need for OOP payments. Ensuring the functionality of community clinics, union level facilities, and upazila health complexes, including a revision of their opening hours would also contribute towards this goal. Ensuring access to pharmaceutical products, particularly for essential NCD-related drugs, at affordable prices could also contribute to a reduction in households OOP payments. In addition to these supply-side interventions, the government could consider demand-side programs where resources follow the patient. For instance, given the large needs and the little resources available, an important pathway to reduce OOP payments while decreasing inequalities would be better targeting public subsidies to the poor and vulnerable. Finally, improving public financial management, policies, and governance will also contribute to the effective use of existing and any additional resources for health.
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“Bonilla-Chacin, Maria Eugenia; Hossain, Md. Rafi; Mahmud, Md. Shahadt Hossain; Amin, Md. Nural; Sarker, Mohammad Abul Bashar; Sadat, Muhammad Anwar; Paul, Subrata; Ahmed, Shakil; Begum, Tahmina; Smith, Owen; Kumar, Anurag. 2020. Pathways to Reduce Household Out-of-Pocket Expenditure. Health, Nutrition and Population Discussion Paper;. © World Bank. http://hdl.handle.net/10986/35658 License: CC BY 3.0 IGO.”
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The poor seeking inpatient care are the most vulnerable to CHE.Publication Out-of-Pocket Expenditures on Health(World Bank, Washington, DC, 2019-04)This paper provides an overview of research on out-of-pocket health expenditures, reviewing the various summary measures and the results of multi-country studies using these measures. The paper presents estimates for 146 countries from all World Bank income groups for all summary measures, along with correlations between the summary measures and macroeconomic and health system indicators. Large differences emerge across countries in per capita out-of-pocket expenditures in 2011 international dollars, driven in large part by differences in per capita income and the share of gross domestic product spent on health. The two measures of dispersion or risk -- the coefficient of variation and Q90/Q50 -- are only weakly correlated across countries and not explained by the macroeconomic and health system indicators. 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