title: Benefit incidence analysis of healthcare in Bangladesh - equity matters for universal health coverage.
abstract: BACKGROUND
  Equity in access to and utilization of healthcare is an important goal for any health system and an essential prerequisite for achieving Universal Health Coverage for any country.
  
  
  OBJECTIVE
  This study investigated the extent to which health benefits are distributed across socioeconomic groups; and how different types of providers contribute to inequity in health benefits of Bangladesh.
  
  
  METHODS
  The distribution of health benefits across socioeconomic groups was estimated using concentration indices. Health benefits from three types of formal providers were analysed (public, private and NGO providers), separated into rural and urban populations. Decomposition of concentration indices into types of providers quantified the relative contribution of providers to the overall distribution of benefits across socioeconomic groups. Eventually, the distribution of benefits was compared to the distribution of healthcare need (proxied by 'self-reported illness and symptoms') across socioeconomic groups. Data from the latest Household Income and Expenditure Survey, 2010 and WHO-CHOICE were used.
  
  
  RESULTS
  An overall pro-rich distribution of healthcare benefits was observed (CI = 0.229, t -value = 9.50). Healthcare benefits from private providers (CI = 0.237, t -value = 9.44) largely favoured the richer socioeconomic groups. Little evidence of inequity in benefits was found in public (CI = 0.044, t -value = 2.98) and NGO (CI = 0.095, t -value = 0.54) providers. Private providers contributed by 95.9% to overall inequity. The poorest socioeconomic group with 21.8% of the need for healthcare received only 12.7% of the benefits, while the richest group with 18.0% of the need accounted for 32.8% of the health benefits.
  
  
  CONCLUSIONS
  Overall healthcare benefits in Bangladesh were pro-rich, particularly because of health benefits from private providers. Public providers were observed to contribute relatively slightly to inequity. The poorest (richest) people with largest (least) need for healthcare actually received lower (higher) benefits. When working to achieve Universal Health Coverage in Bangladesh, particular consideration should be given to ensuring that private sector care is more equitable.
authors.affiliation: Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.|Health Economics and Financing Research Group, Centre for Equity and Health Systems, icddr,b, Bangladesh.|Centre of Excellence for Universal health Coverage, icddr,b and James P Grant School of Public health, BRAC University, Bangladesh.|Health Economics Unit, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jahangir A M
authors.initials: JA
authors.lastname: Khan
authors.affiliation: Health Economics and Financing Research Group, Centre for Equity and Health Systems, icddr,b, Bangladesh.|Centre of Excellence for Universal health Coverage, icddr,b and James P Grant School of Public health, BRAC University, Bangladesh.|Health Economics Unit, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sayem
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: London School of Economics, London, United Kingdom.
authors.forename: Mary
authors.initials: M
authors.lastname: MacLennan
authors.affiliation: Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.|University of Strathclyde, Glasgow, Scotland, UK.
authors.forename: Abdur Razzaque
authors.initials: AR
authors.lastname: Sarker
authors.affiliation: Health Economics and Financing Research Group, Centre for Equity and Health Systems, icddr,b, Bangladesh.
authors.forename: Marufa
authors.initials: M
authors.lastname: Sultana
authors.affiliation: Health Economics Unit, Ministry of Health and Family Welfare, Bangladesh.
authors.forename: Hafizur
authors.initials: H
authors.lastname: Rahman
mesh_terms: D001459:Bangladesh; D006078:Government Programs; D006282:Health Personnel / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006801:Humans; D007348:Insurance, Health; D011203:Poverty; D017149:Private Sector / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D019472:Universal Health Insurance
keywords: Concentration indices; decomposition; equity in health benefits; universal health coverage; urban and rural settings