The government’s portion of health expenditure has been decreasing while individuals’ share is increasing annually.
This has been revealed in a report by the Bangladesh National Health Account, which was presented recently at an event organized by the Health Ministry’s Health Economics Unit.
The report shows that the government’s share of health expenditure was 28%, 26%, and 23% in 2018, 2019, and 2020, respectively. Meanwhile, individuals’ shares were 64%, 66%, and 69% during these years.
The report’s findings indicate a concerning trend in the country’s healthcare system, with individuals bearing a greater burden of health expenses while the government’s expenses continue to decline. The statistics show that the cost of treatment for the rural people has increased significantly compared to that of the metros and cities.
In 2020, the average per capita expenditure on health was Tk 4,578, where individuals’ out-of-pocket spending was two-thirds, or 68.5%. According to that report published in the presence of the minister, the officials of the ministry, and other related officials from various institutes, United Nations offices, and so on, the largest private expenditure recorded to be spent in the medical sector is on medicines, which is 64%.
Dr Subrata Pal, the spokesperson for Bangladesh’s National Health Accounts Cell, stated that according to the results of a survey conducted in the last six months, total expenditure on the health sector in Bangladesh in 2020 was 777.35 billion taka, or 2.8 percent of total Gross Domestic Product (GDP). Moreover, compared to 2015’s per capita expenditure on health of 37 dollars, in 2020 it rose to 54 dollars.
Health minister’s concern
In response to these, the minister of Health and Family Welfare, Zahid Maleque, said, “If we want to control the cost of expenditure in the health sector by individuals, then we have to control the private medicals first, which are taking out a large share of total expenditures made by individuals in the country. Again, a large number of financially well-off families go abroad for treatment purposes, which is also putting pressure on the expenditure amount by number.”
He added, “Many hospital equipment items are malfunctioning every day in various parts of the country, for which individuals are forced to go to private hospitals for checkup examinations. Increased supervision and accountability can undoubtedly be a solution in this case. We have great hope for our future, as the government is expanding its hands in developing infrastructures of hospitals, which means the cost of government in the health sector is continuously increasing.
Zahid Maleque, in his speech, said, “Our per capita expenditure on treatment is $54, lower than Sri Lanka and the Maldives. It needs to be increased.”
Insights from top officials at national and international organisations
A senior official of the World Health Organisation, Vardhan Jung Rana, said in this perspective, “the rise in an individual’s healthcare cost is an obstacle in achieving universal health coverage. Increasing cost is not what people want here. Proper use of these funds is the key, and it is the thing that people also want to see from the authority.”
It is to be noted that the statistics also revealed, “In the city corporation areas only, the poor spend 1% of the total expenditure on health, while the rich spend 67%. The urban poor spend 4%, while the rich spend 53%. And, in rural areas, poor spend 11%, while rich spend 34%. So, the report says, the rich spends much more on health than the poor, spending 8 times more than the poor. Considering this, UNICEF’s Dhaka office head of health, Maya Vandenent, said, “People are facing financial hardship, with many moving below the poverty line, which is pushing people to catastrophic conditions for sure.”
According to the Director General of the Medicine Administration department, Major General Mohammad Yusuf, “Drug prices have risen due to the Covid pandemic, the Russia-Ukraine war, and an increase in the dollar price, making it difficult to keep them stable. But we are working hard to keep drug prices within the reach of the general public.”