It is nothing surprising that medical spending in Bangladesh has gone beyond the means of most households. The government's laissez-faire approach to the activities of the health sector has only made it possible.
A report published in this paper on Thursday quoting the latest Household Income and Expenditure Survey (HIES), done by the Bangladesh Bureau of Statistics (BBS),said the health-related expenditures of every household have almost doubled over the past 12 years. Every household, on an average, now spends nearly 7.0 per cent of its monthly income on health. The percentage was 3.79 per cent in 2010 and 4.54 per cent in 2016. The average health-related spending is higher in rural areas than that in urban areas, the survey noted.
In the case of illness, people generally are required to spend money mainly on four heads---physicians' fees, cost of medicines, diagnostic test charges and spending on hospitals/clinics. Not that such spending involves all four at a time. Hospitalisation becomes necessary only in serious cases. Visits to physicians and subsequent purchase of medicines are primary health-related expenditures. Both have become too expensive in recent years. Doctors, particularly the specialists, have raised their fees two to threefold during the period under review. The prices of medicines, barring a few essential ones on the government's list, have increased unabatedly. Diagnostic charges have also gone up by a big margin.
If and when hospitalisation is required, poor and low-income families throng government hospitals and health complexes that are few and have limited facilities to offer to their patients. Some big public facilities remain overwhelmed with incoming patients. Many patients return home frustrated failing to get a place in these health facilities. However, patients who can manage admission are also required to buy a large part of their medicines from outside pharmacies. Yet treatment in public hospitals is far cheaper than that in private health facilities.
The health-related spending for poor and low-income families emerges as a major burden. They often, as mentioned in the BBS survey, are forced to cut food and education provisions to pay for such expenditures. In the case of serious ailments, these families become helpless. Even middle-income families have to spend their savings and turn to friends and relatives for financial help.
The situation is very much disappointing in the health sector as the support from the State is awfully meagre compared to the needs of teeming millions. This is evident from the level of out-of-pocket health expenditure (OoPHE) of every family in the country. The latest government Health Accounts Survey has revealed that OoPHE has increased to 68.5 per cent in 2022 from 63.3 in 2012.
Unfortunately, the government has been indifferent to the need for mitigating the sufferings of the poor and low-income people as far as health-related expenses are concerned. The government spending on the health sector, on the one hand, has remained very low and, on the other, the authorities are found reluctant to put a leash on the soaring prices of medicines and fees of private hospitals and clinics.
There is no denying that domestic pharmaceutical companies have made remarkable progress since 1982 when the National Drug Policy was introduced to curb the dominance of foreign players in the sector. But there should be a price-control mechanism to keep the prices of medicines within the reach of the poor and low-income people. Drug manufacturers spend a lot of money on promotional activities. They even bribe senior physicians at government hospitals to get their respective products on the latter's prescriptions. Doctors at posh private hospitals in Dhaka are not allowed to prescribe medicines in their brand names. Only generic names are used. The government can well issue a directive to this effect to help cut the large amount now being spent on promotional activities by drug companies. This would help lower the prices of medicines.
The government should also fix maximum slabs for doctors' fees, diagnostic charges and rents for beds in wards and cabins of private hospitals. There could be a categorisation of hospitals for such rate fixation.