The bane of out-of-pocket health expenditure

A study carried out recently by a researcher at the Bangladesh Institute of Development Studies (BIDS) shows that "Out-of-Pocket (OOP) expenditure is one of the most noteworthy payment strategies for healthcare in Bangladesh and the share of the same has been increasing alarmingly." The findings were presented at a programme titled "Catastrophic Health Shock and Improvement in Bangladesh: Insights HES-2022."

For several years, OOP has come up for discussion as patients in the country are constantly being squeezed out of their savings while trying to meet healthcare costs. Indeed, Dr. Razzaque who conducted the research stated at the event that "54.40 per cent of OOP money is spent on purchasing medicines while diagnostic cost is 27.52 per cent, 10.31 per cent cost for consultation and 7.77 per cent expenditure for transport cost." What the latest survey reveals is that due to this excessive OOP expenditure, about 6.13 million people were pushed below the national poverty line in 2022. It is a large number of people. While the health minister has stated that the government is working towards a law titled 'Health Protection Act', the question is how long will that take?

Granted that the minister has not been in the chair long, but experience shows that business interests and profit generation in the health sector is an entrenched practice that operates on the principle of maximising earnings at the cost of patients. Again, would a piece of legislation automatically translate into action? One can easily draw parallels with the market for foodstuffs across wholesale and retail markets in the country, where several laws exist to protect consumer rights, but have they been effectively enforced to protect consumers from wilful manipulation of prices? Sadly, the answer is no.

There has also been talk about introduction of healthcare insurance. This would be a move in the right direction. There are many examples of such insurance schemes that have worked in other parts of the world, but how would the authorities go about enforcing it? The problem in Bangladesh is not having requisite laws, but their enforcement. Again, as the minister has stated many times before, no radical change can be expected overnight. Agreed. But, the pace of change must be expedited because people are being made to suffer inordinately and these malpractices have been going on for decades. There are various stakeholders involved here from manufacturing of medicines to their prescription at heath institutions to the prices of drugs.

The lack of oversight on these and institutions that carry out tests and the fact that most of the Grade A health institutions and health practitioners are largely in urban areas, mean that patients living rural areas must travel from far and wide to come to the cities, pay hotel bills, transportation, etc. to get those services. These are all facts of life and every Bangladeshi knows the score. There is nothing that they can do about it. It is up to the state to care for its citizens in a manner that puts a patient over profit and above unbridled greed. Malpractices manifest themselves in every facet of the healthcare system in absence of a rule-based system. Yes, the minister is correct when he says the entrenched system of fleecing patients cannot be changed overnight, but at least he can try to do something. Time is money and people have been pushed beyond tolerance levels with runaway inflation affecting every facet of their lives. They need relief now.

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