Cost of caregivers for treating hospitalized diarrheal patients in Bangladesh

Diarrheal diseases are a global public health problem and one of the leading causes of mortality, morbidity and economic loss. The objective of the study is to estimate the economic cost of caregivers and cost distribution per diarrheal episodes in Bangladesh. This was a cross-sectional hospital-based study conducted in public hospitals in Bangladesh. A total of 801 diarrheal patients were randomly selected and interviewed during January to December 2015. Simple descriptive statistics including frequencies, percentage, mean with 95% CI and median are presented. The overall average cost of caregivers was BDT 2243 (US$28.58) while only BDT 259 (US$ 3.29) was spent as out of pocket payments. Caregivers mostly spent money (US$1.63) for food, lodging, utility bills, and other lump sum costs followed by the transportation costs (US$ 1.57). The caregivers spent more (US$44.45) when they accompanied the patients who were admitted in inpatients care and almost 3.6 times higher than for out-patients care (US$ 12.42). The study delivers an empirical evidence to the health-care programmers and policy makers about the economic cost of caregivers during diarrheal treatment care, which should be accounted for in designing future diarrheal prevention programme

Measuring the efficiency of health systems in Asia: a data envelopment analysis

Objective This study aims to estimate the technical efficiency of health systems in Asia. Settings The study was conducted in Asian countries. Methods We applied an output-oriented data envelopment analysis (DEA) approach to estimate the technical efficiency of the health systems in Asian countries. The DEA model used per-capita health expenditure (all healthcare resources as a proxy) as input variable and cross-country comparable health outcome indicators (eg, healthy life expectancy at birth and infant mortality per 1000 live births) as output variables. Censored Tobit regression and smoothed bootstrap models were used to observe the associated factors with the efficiency scores. A sensitivity analysis was performed to assess the consistency of these efficiency scores. Results The main findings of this paper demonstrate that about 91.3% (42 of 46 countries) of the studied Asian countries were inefficient with respect to using healthcare system resources. Most of the efficient countries belonged to the high-income group (Cyprus, Japan, and Singapore) and only one country belonged to the lower middle-income group (Bangladesh). Through improving health system efficiency, the studied high-income, upper middle-income, low-income and lower middle-income countries can improve health system outcomes by 6.6%, 8.6% and 8.7%, respectively, using the existing level of resources. Population density, bed density, and primary education completion rate significantly influenced the efficiency score. Conclusion The results of this analysis showed inefficiency of the health systems in most of the Asian countries and imply that many countries may improve their health system efficiency using the current level of resources. The identified inefficient countries could pay attention to benchmarking their health systems within their income group or other within similar types of health systems

The Impact of Community-Based Health Insurance on the Utilization of Medically Trained Healthcare Providers among Informal Workers in Bangladesh

We aimed to estimate the impact of a Community-Based Health Insurance (CBHI) scheme on utilization of healthcare from medically trained providers (MTP) by informal workers. A quasi-experimental study was conducted where insured households were included in the intervention group and uninsured households in comparison group. In total 1,292 (646 insured and 646 uninsured) households were surveyed from Chandpur district comprising urban and rural areas after 1 year period of CBHI introduction. Matching of the characteristics of insured and uninsured groups was performed using a propensity score matching approach to minimize the observed baseline differences among the groups. Multilevel logistic regression model, with adjustment for individual and household characteristics was used for estimating association between healthcare utilization from the MTP and insurance enrolment. The utilization of healthcare from MTP was significantly higher in the insured group (50.7%) compared to the uninsured group (39.4%). The regression analysis demonstrated that the CBHI beneficiaries were 2.111 (95% CI: 1.458-3.079) times more likely to utilize healthcare from MTP.CBHI scheme increases the utilization of MTP among informal workers. Ensuring such healthcare for these workers and their dependents is a challenge in many low and middle income countries. The implementation and scale-up of CBHI schemes have the potential to address this challenge of universal health coverage

Analyzing Benefit-Cost Ratio of Health Interventions for Improving Maternal and Child Mortality and Child Immunization in Bangladesh: Benefits and Costs of Reducing Maternal and Neonatal Mortality and Increasing Child Immunization in Bangladesh

No abstract available

Impact of educational intervention on willingness-to-pay for health insurance: a study of informal sector workers in urban Bangladesh

Background: The reliance on out-of-pocket payments for health services leads to a catastrophic burden for many households in Bangladesh. The World Health Organization suggests that risk-pooling mechanisms should be used for financing healthcare. Like many low-income countries (LIC), a large share of employment in Bangladesh is in the informal sector (88%). Inclusion of these workers in health insurance is a big challenge. Among other barriers, the “literacy gap” for health insurance” is a reason for the low insurance uptake in Bangladesh. The aim of this study is, therefore, to assess the impact of an educational intervention on willingness-to-pay (WTP) for health insurance among informal sector workers in urban Bangladesh. Method: An educational intervention on occupational solidarity and health insurance is offered to groups of informal workers. Educational sessions take place once a week (3–4 hours) during three subsequent weeks for each occupational group. For assessing the impact of the educational intervention, WTP for joining health insurance using occupational solidarity between workers in “pre- and post-treatment” periods as well as between “control and treatment” groups were compared. Multiple-regression analysis is applied for predicting WTP by educational intervention, while controlling for demographic and socioeconomic characteristics. Results: The coefficient of variation (CoV) of the WTP is estimated in control and treatment groups and expected to be lower in the latter. The WTP for health insurance is higher (33.8%) among workers who joined the educational intervention in comparison with those who did not (control group). CoV of WTP is found to be generally lower in post-treatment period and in treatment group compared to pre-treatment period and control group respectively. Conclusion: Educational interventions can be used for increasing demand for health insurance scheme using occupational solidarity among informal sector workers

A transparent Universal Health Coverage index with decomposition by socioeconomic groups: application in Asian and African settings

Background: Health and wellbeing as one of the Sustainable Development Goals requires all countries to achieve Universal Health Coverage (UHC). That is, all people must have access to healthcare when needed at an affordable price. While several indices were developed recently to assess UHC status, these indices appeared to be difficult for practitioners to apply without statistical knowledge. Objective: This paper presents a transparent and step-by-step practical calculation method of such an index using Excel spreadsheets, applied to some Asian and African countries. We also decompose the contribution of socioeconomic groups to UHC index values. Methods: We utilized the well known UHC illustration (three-dimensional box, showing population coverage, service coverage and financial protection) to calculate the UHC index. We also broke down the index into socioeconomic groups. For validation, correlation coefficients between our index and other UHC indices were calculated and the relationship of our index with out-of-pocket (OOP) payments was estimated. Results: World Bank data from six Asian and 15 African countries on health-service coverage of people in five socioeconomic quintiles with financial protection were used to calculate our UHC index. Among the Asian countries, indices ranged between 26.0% (Nepal) and 58.7% (Kazakhstan), while in African countries indices ranged between 8.9% (Chad) and 55.3% (Namibia). Decomposition of the UHC index showed a higher contribution to the index by richer socioeconomic groups. The correlation coefficients between our estimated UHC index values and those of others ranged between 0.774 and 0.900. Our index reduced by 1.4% in response to a 1% increase in OOP payments. Conclusions: This spreadsheet approach for calculating the UHC index appeared to be useful, where the interrelation of UHC dimensions was easily observed. Decomposition of the index could be useful for policy-makers to identify the subpopulations and health services with need for further interventions towards UHC achievement

The impact of age and sex on healthcare expenditure of households in Bangladesh

The impact of age and sex on health care expenditure has recently become one of the major concerns in many developing countries like Bangladesh. Age and sex differences in the use of health care services can be substantial at several stages of life which are reflected in overall healthcare expenditure. We examined the impact of age and sex of the population on overall healthcare expenditure of households in Bangladesh. A total of 10,705 populations who spent for receiving any type of healthcare services were analyzed from Bangladesh Household Income and Expenditure Survey data, 2010. Sex and age group were considered as childhood (0–19), young adult (20–39), middle-aged adult (40–64), senior aged (65–84) and old senior aged (84+) for the entire analysis. Total healthcare expenditure was derived by considering direct cost such as physician’s fee, cost of medicine, diagnostic, transportation, tips and informal payment etc. Indirect and intangible cost was not considered in the analysis. The study found that overall health care expenditure of male (US$11.5) is higher than female (US$ 11.2) while this is higher for female (US$14.2) than male (US$ 11.3) in the reproductive age. The highest health expenditure was observed in male (US$69.7) of age 65–69 years and in female (US$ 23.4) of age 75–79 years. The cost for hospitalization was significantly higher (US $23.7) for female than male (US$ 21.1). Overall health expenditure was observed to be significantly higher in elderly than younger people. These findings provide an experimental framework for the continuing inquiry of equity in the allocation of health care expenditure between male and female at different age, which suggest current health care system in Bangladesh place a significant financial strain on the elderly population

Clients’ Experience and Satisfaction of Utilizing Healthcare Services in a Community Based Health Insurance Program in Bangladesh

Background: Community-based health insurance is recognized as a promising tool for health system improvement for low-income people that improves the health status of enrolees and enhances productivity and labor supply. The experience and opinion of the clients who utilized health services through the insurance scheme are important for improving healthcare services, shaping health policies and providing feedback on the quality, availability, and responsiveness of healthcare services. However, studies focusing on clients’ satisfaction provided by the health insurance scheme are still limited globally. Objective: To address this knowledge gap, this current study attempted to measure the degree of clients’ satisfaction towards healthcare services and insurance scheme, based on their experience of health care which will serve the future reference point to implement potential quality improvement initiatives of community-based health insurance program. Methods: A cross-sectional household survey was conducted within the catchment area of a community-based health insurance pilot program named Labor Association for Social Protection (LASP) during April–June 2014 to compare the evaluation of healthcare services provided by LASP scheme. In the descriptive analyses, the characteristics of the study participants were presented regarding frequency and the percentages with 95% confidence interval. Spearman correlation analysis was conducted between the satisfaction score of each indicator and overall satisfaction score; multivariate linear regression analysis was used to identify the factors associated with overall health scheme satisfaction. Results: The overall satisfaction mean score was 4.17 ± 0.04 (95% CI: 4.08–4.26) out of 5.00. The most satisfied domains were related to the diagnostic services (4.46 ± 0.98), explanation about the prescribed medicine (4.23 ± 0.81), the surrounding environment of healthcare facility (4.21 ± 0.70) and the behavior of health personnel toward clients (4.18 ± 0.73). Conclusions: Our study observed that the overall satisfaction level towards health services is quite favorable, but satisfaction scores can still be improved. These findings could contribute towards developing and designing the healthcare services packages of community-based health scheme which is in line with the health care financing strategy of Bangladesh as well as the recommendation of the World Health Organization for developing social health insurance as part of path to Universal Health Coverage

Caesarean Delivery in Urban Slums of Dhaka City: Indications and Consequences

No abstract available

Distribution of chronic disease mortality and deterioration in household socioeconomic status in rural Bangladesh: an analysis over a 24-year period

Background: Little is known about long-term changes linking chronic diseases and poverty in low-income countries such as Bangladesh. This study examines how chronic disease mortality rates change across socioeconomic groups over time in Bangladesh, and whether such mortality is associated with households falling into poverty. Methods: Age-sex standardized chronic diseases mortality rates were estimated across socioeconomic groups in 1982, 1996 and 2005, using data from the health and demographic surveillance system in Matlab, Bangladesh. Changes in households falling below a poverty threshold after a chronic disease death were estimated between 1982–96 and 1996–2005. Results: Age-sex standardized chronic disease mortality rates rose from 646 per 100 000 population in 1982 to 670 in 2005. Mortality rates were higher in wealthier compared with poorer households in 1982 [Concentration Index = 0.037; 95% confidence interval (CI): 0.002, 0.072], but switched direction in 1996 (Concentration Index = −0.007; 95% CI: −0.023, 0.009), with an even higher concentration in the poor by 2005 (Concentration Index = −0.047; 95% CI: −0.061, −0.033). Between 1982–96 and 1996–2005, the highest chronic disease mortality rates were found among those households that fell below the poverty line. Households that had a chronic disease death in 1982 were 1.33 (95% CI: 1.03, 1.70) times more likely to fall below the poverty line in 1996 compared with households that did not. Conclusions: Chronic disease mortality is a growing proportion of the disease burden in Bangladesh, with poorer households being more affected over time periods, leading to future household poverty