Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?

<h4>Introduction</h4>Out-of-pocket (OOP) payments for healthcare severely affect the current consumption, future health and earnings capacity of poor/underprivileged households and hence it is crucial for priority setting. This study assesses the variation in overall as well as disease-s...

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Autores principales:	Afroza Begum, Syed Abdul Hamid
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f66fdfce857e4a37ab900c88ad617e96
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spelling	oai:doaj.org-article:f66fdfce857e4a37ab900c88ad617e962021-12-02T20:07:17ZImpoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?1932-620310.1371/journal.pone.0252706https://doaj.org/article/f66fdfce857e4a37ab900c88ad617e962021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252706https://doaj.org/toc/1932-6203<h4>Introduction</h4>Out-of-pocket (OOP) payments for healthcare severely affect the current consumption, future health and earnings capacity of poor/underprivileged households and hence it is crucial for priority setting. This study assesses the variation in overall as well as disease-specific impoverishment impact of OOP payments between the regions experiencing different climate change risks, defined as high disaster-prone (HDP) areas and low-disaster-prone (LDP) areas, in Bangladesh.<h4>Materials and methods</h4>This paper estimated three poverty measures, such as poverty headcount, poverty intensity and normalized poverty gap for all ailments, catastrophic events, diseases types (communicable, non-communicable (NCDs), and accident and injury), illness conditions (acute and chronic) and hospitalization using 3,791 randomly selected rural households (1,203 from HDP and 2,588 from LDP areas) across the regions. Cost of basic need approach was used for estimating poverty line expenditure.<h4>Results</h4>About 13 percent households annually fall into poverty due to OOP outlays for healthcare. Despite having significantly (p-value≤0.01) less OOP payments (HDP areas: BDT 5,117; LDP areas: BDT5,811) the impoverishment impact of OOP payments for healthcare in HDP areas (16.5%) has substantially higher than LDP areas (11.3%). Population in HDP areas, especially char (river island; 19.55 percent) and haor (water submerged; 16.80 percent) are more susceptible to any level of OOP payments due to low level of earnings. Catastrophic healthcare expenditure (61.79%) and NCDs (14.29 percent) are exacerbating the poverty level in Bangladesh. Both absolute and relative average poverty gap are more widen in HDP than LDP areas due to catastrophic OOP outlays for healthcare.<h4>Conclusion</h4>The impoverishment effect due to OOP payments for healthcare in both HDP and LDP areas are high, especially for NCDs and catastrophic healthcare expenditure. However, the situation is bit worse in HDP areas. Preventing the escalation of NCDs as well as catastrophic expenditure and hence reducing the level of impoverishment thereof call for restricting tobacco use, increasing physical activity, encouraging to intake healthy diets, ensuring food safety, controlling air pollution, and improving mental health. Moreover, government should give more emphasis, especially in the HDP areas, on making community clinics more functional through providing screening equipment and training to the Community Health Care Providers for early detection of NCDs, and ensuring availability of medicine all the time. Note that other than community clinics, there is little option for providing healthcare in HDP areas due to poor functionality of public facilities as well as lack of private facilities in HDP areas.Afroza BegumSyed Abdul HamidPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252706 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Afroza Begum Syed Abdul Hamid Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?
description	<h4>Introduction</h4>Out-of-pocket (OOP) payments for healthcare severely affect the current consumption, future health and earnings capacity of poor/underprivileged households and hence it is crucial for priority setting. This study assesses the variation in overall as well as disease-specific impoverishment impact of OOP payments between the regions experiencing different climate change risks, defined as high disaster-prone (HDP) areas and low-disaster-prone (LDP) areas, in Bangladesh.<h4>Materials and methods</h4>This paper estimated three poverty measures, such as poverty headcount, poverty intensity and normalized poverty gap for all ailments, catastrophic events, diseases types (communicable, non-communicable (NCDs), and accident and injury), illness conditions (acute and chronic) and hospitalization using 3,791 randomly selected rural households (1,203 from HDP and 2,588 from LDP areas) across the regions. Cost of basic need approach was used for estimating poverty line expenditure.<h4>Results</h4>About 13 percent households annually fall into poverty due to OOP outlays for healthcare. Despite having significantly (p-value≤0.01) less OOP payments (HDP areas: BDT 5,117; LDP areas: BDT5,811) the impoverishment impact of OOP payments for healthcare in HDP areas (16.5%) has substantially higher than LDP areas (11.3%). Population in HDP areas, especially char (river island; 19.55 percent) and haor (water submerged; 16.80 percent) are more susceptible to any level of OOP payments due to low level of earnings. Catastrophic healthcare expenditure (61.79%) and NCDs (14.29 percent) are exacerbating the poverty level in Bangladesh. Both absolute and relative average poverty gap are more widen in HDP than LDP areas due to catastrophic OOP outlays for healthcare.<h4>Conclusion</h4>The impoverishment effect due to OOP payments for healthcare in both HDP and LDP areas are high, especially for NCDs and catastrophic healthcare expenditure. However, the situation is bit worse in HDP areas. Preventing the escalation of NCDs as well as catastrophic expenditure and hence reducing the level of impoverishment thereof call for restricting tobacco use, increasing physical activity, encouraging to intake healthy diets, ensuring food safety, controlling air pollution, and improving mental health. Moreover, government should give more emphasis, especially in the HDP areas, on making community clinics more functional through providing screening equipment and training to the Community Health Care Providers for early detection of NCDs, and ensuring availability of medicine all the time. Note that other than community clinics, there is little option for providing healthcare in HDP areas due to poor functionality of public facilities as well as lack of private facilities in HDP areas.
format	article
author	Afroza Begum Syed Abdul Hamid
author_facet	Afroza Begum Syed Abdul Hamid
author_sort	Afroza Begum
title	Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?
title_short	Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?
title_full	Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?
title_fullStr	Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?
title_full_unstemmed	Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?
title_sort	impoverishment impact of out-of-pocket payments for healthcare in rural bangladesh: do the regions facing different climate change risks matter?
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/f66fdfce857e4a37ab900c88ad617e96
work_keys_str_mv	AT afrozabegum impoverishmentimpactofoutofpocketpaymentsforhealthcareinruralbangladeshdotheregionsfacingdifferentclimatechangerisksmatter AT syedabdulhamid impoverishmentimpactofoutofpocketpaymentsforhealthcareinruralbangladeshdotheregionsfacingdifferentclimatechangerisksmatter
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Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?

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