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Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing

Bangladesh health systems financing (HSF) is characterized by increasingly high out-of-pocket (OOP) payments, and, at the same time, the absence of an active prepayment system.

Out-of-pocket payments as percent of private expenditure on health (92.9%) is higher than India (89.2%) and Nepal (79.9%) [19]. The Bangladesh National Health Accounts reports that household OOP expenditure remains the main source of HSF, increasing from 56.9% in 1997 to 63.3% in 2012 of total health expenditure (THE). The second largest financing agent is government, making up 26.0% of THE. The private firms’ share has remained at around 1.0% over the years. The share of non-government organizations (NGOs) from their own sources has ranged between 1% and 2.0% of the THE over the 1997–2012 period.

Development partners contribute through NGOs or government. The rest of the expenditure through NGOs varied from 5% to 9% during the period. Household expenditure as a percentage of GDP increased from 1.6% to around 20.0% in 2010.

The health spending in Bangladesh accounted for 3.4% of gross domestic product (GDP), which is lower than the average (3.8%) in South East Asia (SEA) region, below the average of low-income countries (5.4%), lower-middle income countries (4.3%), and far below the world (8.5%). A breakdown of OOP expenditure shows that drugs and medicine constitute 65.0% of OOP spending. Other components of OOP are services of curative care (22.0%), ancillary services (9.0%), out-patient and home-based services (4.0%), and general government administration of health (less than 1.0%).

In this paper, it aimed to see who pays what part of this high OOP expenditure.


Dr. Azaher Ali Molla is an Associate Professor of Public and Community Health in the Department of Applied Health Sciences at the Murray State University, USA. He is an M.D., and a Ph.D. in Public Health concentrated in Health Policy. He has two masters; one in Primary Health Care Management (MPHM) and another one in Health Economics (MSc in HE). He worked as a tenured faculty (Associate Professor) in the Institute of Health Economics, the University of Dhaka, Bangladesh, for 12 years. At Murray State University (MSU), he teaches Biostatistics, Epidemiology, Personal Health, Healthcare Financing, Healthcare Planning, Healthcare Quality Management, and Research Methods. He has published 15 research articles in peer-reviewed journals, including BMC Health Services Research and BMC International Journal for Equity in Health. His present research includes Determinants of Access to Preventive Healthcare, Financial Hardship of Medicare Patients, and healthcare expenditure and poverty. He was the presenter at the American Public Health Association (APHA) Annual Conference in 2017 and 2019.

Dr. Molla was the recipient of Lana Porter Open Access Award in 2018. He is an active member of the International Health Economics Association (iHEA), APHA, and the Global Forum for Health Research. Dr. Molla likes to teach quantitative Research Methods and supervise research students at masters and doctoral levels. He also serves as the Editorial Board Member of the Amity Journal of Health Care Management.

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Meeting ID: 920 1991 7806

Wednesday, December 1, 2021 at 5:00pm to 6:15pm

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Health and Well-being, Research


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College of Public Health and Human Sciences
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Chunhuei Chi, MPH, Sc.D. (He, His)

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