title: Health-related financial catastrophe, inequality and chronic illness in Bangladesh.
abstract: BACKGROUND
  Bangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP) payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk.
  
  
  OBJECTIVE
  This study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe.
  
  
  METHODS
  A cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively.
  
  
  RESULTS
  On average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults.
  
  
  CONCLUSIONS
  Households that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by reducing the health system's dependency on OOP payments and providing more financial risk protection.
authors: Department of Global Health Policy, The University of Tokyo, Tokyo, Japan. mizanur_rub@yahoo.com
authors: Md Mizanur
authors: MM
authors: Rahman
authors: Stuart
authors: S
authors: Gilmour
authors: Eiko
authors: E
authors: Saito
authors: Papia
authors: P
authors: Sultana
authors: Kenji
authors: K
authors: Shibuya
mesh_terms: D001459:Bangladesh; D002388:Catastrophic Illness / Q000191:economics*; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D012959:Socioeconomic Factors