title: Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh.
abstract: OBJECTIVE
  As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh.
  
  
  METHODS
  A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method.
  
  
  RESULTS
  The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures.
  
  
  CONCLUSIONS
  The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.
authors.affiliation: Health Economics and Financing Research, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Rashidul Alam
authors.identifier: 0000-0001-9788-1868
authors.initials: RA
authors.lastname: Mahumud
authors.affiliation: Health Economics and Financing Research, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.|Department of Management Science, University of Strathclyde Business School, Glasgow, United Kingdom.
authors.forename: Abdur Razzaque
authors.identifier: 0000-0002-2022-7590
authors.initials: AR
authors.lastname: Sarker
authors.affiliation: Health Economics and Financing Research, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Marufa
authors.identifier: 0000-0002-4481-0748
authors.initials: M
authors.lastname: Sultana
authors.affiliation: Health Economics and Financing Research, Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Ziaul
authors.identifier: 0000-0002-6904-7902
authors.initials: Z
authors.lastname: Islam
authors.affiliation: Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom.|Health Economics Unit, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jahangir
authors.identifier: 0000-0003-0181-9301
authors.initials: J
authors.lastname: Khan
authors.affiliation: Department of Management Science, University of Strathclyde Business School, Glasgow, United Kingdom.
authors.forename: Alec
authors.identifier: 0000-0003-3803-8517
authors.initials: A
authors.lastname: Morton
mesh_terms: D000328:Adult; D000368:Aged; D001459:Bangladesh; D003695:Delivery of Health Care / Q000191:economics*; D003710:Demography; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Bangladesh; Gross domestic product per capita; Out-of-pocket; Risk pooling mechanism; Social financial safety