Out-of-pocket healthcare expense pushes 5.0m into poverty a year
Catastrophic health expenditure due to rise in non-communicable diseases (NCDs) has been pushing over five million people to below poverty line every year, creating impediment to achieving health-related Sustainable Development Goals (SDGs) by 2030.
Expressing deep concerns, both health minister and secretary said on Saturday the high out-of-pocket expenditure should be revised by health economics unit (HEU) and be reduced significantly by 2030.
Side by side, the per capita health expenditure should be raised from the present $ 50 and health workforce should be deployed in line with the World Health Organisation (WHO) standard.
“People are becoming poor due to catastrophic health expenditure. Chronic NCDs are increasing in the country causing huge expenditure for treatment year after year making people poor. We need protection here,” said Health Minister Zahid Maleque.
They made the observations at a programme organised marking the Universal Health Coverage Day 2020 at a city hotel.
Health economics unit of the health ministry organised the programme with support of WHO, UKAid.
Health Minister Zahid Maleque was present as the chief guest.
This year UBC Day was observed with the theme ‘Health For All: Protect Everyone’.
Health Services Division Secretary Abdul Mannan, however, differed with the 67 per cent out-of-pocket (OOP) expenditure in Bangladesh saying the government has been providing almost everything free in the public hospitals except for nominal charges for investigation.
Zahid Maleque said multi-sectoral approach is required to ensure universal health coverage as it involves finance and resources, manpower, healthcare facilities, woman empowerment, education and technology.
“It is not enough to have health facilities only for UHC, rather adequate health workforce is vital too. WHO said Bangladesh needs 0.2 million doctors and 0.6 million nurses while there are 30,000 doctors and 40,000 nurses in the public sector. Over 60,000 doctors are there in private sector and 0.1 million nurses in public and private sectors combinedly. There is a huge gap here,” he said.
The minister also said health budget is very low here compared to the neighbouring countries where it is over 3.0 to 4.0 per cent and in Europe it is 19 per cent.
The OOP is very high which is 67 per cent here, of which 40 per cent are spent for medicine.
Per capita health expenditure is also very low in the country which is only $50 whereas it is $10,000-12,000 in Europe.
“This amount of per capita health expenditure has to be mounted significantly to achieve UHC. Besides, we need capacity to implement planning,” said Zahid Maleque.
He also pointed out that many health indicators have been suffering as urban primary healthcare is in the hand of the local government which does not have the health facilities.
Time has come to take over it and the process has started, he added.
The minster claimed that the government has spent on an average Tk 0.45 million for ICU Covid patients, Tk 0.13 million for IPD patients.
The health secretary said that 5.0 million people are slipping to below poverty line every year due to catastrophic health expenditure is a shocking thing.
HEU should investigate more into the matter because overall poverty has been reducing in the country.
Referring to the high OOP, he said it is not true as the government is providing treatment free of cost except for nominal charges for investigation.
About 29 types of medicines are provided for free and the government has spent more than Tk 3.50 billion during pandemic for treating the Covid patients.
Nowhere in the world it is happening except for Bangladesh, he claimed.
He said the equipments at public hospitals get out of order very fast which is rare in private hospitals. There is lack of seriousness.
Referring to data on pharmaceutical companies, MA Mannan said 30 companies are exporting medicines and earning $ 140 million.
But more money than the export earning is being sent out for treatment purpose abroad.
Of the total money spent abroad for treatment, 60 per cent goes in India, Thailand and Singapore, the secretary added.
In a study of HEU, per patient expenditure in four Covid hospitals in Dhaka was Tk 3,298 for out patients, Tk 0.12 million for in-patients and Tk 0.38 million for ICU Covid patients.
Per day expenditure at OPD was nil, at IPD Tk 10,712 and Tk 38,390 at ICU.
Average length of stay has been considered 12 days and 10 days for IPD and ICU patients respectively.
HEU said 65 per cent was spent for human resources, 14 per cent for medicine, 2.5 per cent for investigation, 4.5 per cent for utilities, 0.8 per cent for equipment, and 0.9 per cent for transportation.