Per capita health expenses on the rise

The news that annual per capita medical expenses in Bangladesh are rising which is somewhat alarming given the fact that Bangladesh made significant strides in the health sector in terms of health infrastructures including medical colleges, hospitals and clinics in both public and private sectors and rural health centres and community clinics in public sector across the country. In addition, a satisfactory level of progress has been made in family planning and population growth rate has been brought down. Bangladesh National Health Accounts while revealing the news in its latest report maintained that annual out of pocket health expenses of individuals increased by 37 per cent over the last few years and stood at US$27 when last of its report was prepared.  

The news is disconcerting if not entirely alarming, because it undermines the efficiency of the huge network of physicians, both government and private, spread all over the country and those engaged in health care management and is inconsistent with the goal to achieve universal health coverage (UHC). More importantly, despite rising per capita health expenses the government's share in total spending on health still remains low which clearly indicates that private money is still financing the major portion of the health care industry. The present rate of individual out-of-pocket expenses is 61 per cent of the total health expenditure in Bangladesh against a declining government's share of 23 per cent at present from 27 per cent in 2008 which is quite depressing compared to other countries in the South Asia.

Although Bangladesh has been consistently maintaining a steady growth rate of 6-7 per cent throughout the previous decade, a merely 3.0 per cent of our GDP is being spent by the government in the health sector compared to 8-12 per cent in the developed countries according to reports by WHO.

Furthermore, people of Bangladesh spend more than 63 percent of their total health spending from their own pocket which is one of the highest in the region. As a result, people sitting at the base line of poverty are being further impoverished and there are growing evidences that households are pushed into poverty when faced with substantial medical expenses. Reduction in household healthcare expenditure is essential to set up effective health system finance policy for any country and is particularly important for promoting equitable financial burden in healthcare.

However there are some genuine reasons for rising healthcare costs. They are: increased aging population, more prevalence of chronic diseases, and availability of more technically sophisticated and expensive treatments.

Against the backdrop of mounting health expenses, the government has been maintaining a lower allocation in this sector. In the national budget for FY 2017-18, health sector allocation is only 4.04 per cent of the total budget size, the lowest in percentage terms in the last fourteen years. This means that  the government is not increasing its health budget and thus making people carry the burden. To improve the situation, first of all budget allocation for health sector will have to be increased. Side by side, facilities should be expanded in public hospitals and clinics and prices of medicines should be lowered. Public hospitals should be able to supply medicines to be provided free by the government.

Monitoring of public hospital activities should be strengthened and emphasis should be given to proper maintenance and optimum utilization of the equipments.

Added attention must be given to develop more trained medical professionals. Health insurance coverage, particularly in rural areas should be introduced. Public hospitals should be located at strategically convenient points so that patients from surrounding areas can travel easily to avail better treatment facilities.

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