Financial risk protection of heart disease‐affected households in Bangladesh: Insights from nationwide income and expenditure surveys

• Published in: World medical and health policy
• Main Authors: Rahman, Taslima, Gasbarro, Dominic, Alam, Khurshid
• Format: Journal Article
• Language: English
• Published: 15-10-2024
• ISSN: 1948-4682; 1948-4682
• DOI: 10.1002/wmh3.639

Abstract This study assesses the financial risk protection (FRP) of heart disease‐affected households in Bangladesh by analyzing three rounds of Household Income and Expenditure Survey data (2005, 2010, and 2016). Amidst a global surge in cardiovascular diseases, particularly in low‐ and middle‐income countries, Bangladesh encounters an escalating burden of heart disease, with an over‐reliance on out‐of‐pocket (OOP) healthcare expenses. Our findings reveal a substantial increase in annual OOP spending for households affected by heart disease, from USD 307.4 in 2005 to USD 346.1 in 2010, and then surging to USD 650.5 in 2016. Concurrently, catastrophic health expenditure (CHE) and impoverishment incidences rose (17.6% to 18.2% to 29.3% and 3.2% to 2.2% to 3.3%, respectively), with a notable increase post‐2010. These expenses and CHE incidences were consistently higher than those in households with any ailment, underscoring a disparity in FRP, especially among economically disadvantaged, rural households and those headed by individuals without formal education. The study contributes to the literature by providing a first‐time analysis of FRP dynamics against heart disease in Bangladesh using comprehensive national data. It uncovers the worsening FRP status among affected households and highlights the need for targeted interventions to enhance FRP, particularly among the most vulnerable groups. Additionally, it emphasizes the importance of strategic public health investments to mitigate the financial repercussions of heart disease care, providing insights that are globally applicable to similar contexts.
摘要 本研究通过分析三轮家庭收入和支出调查数据（2005年、2010年、2016年），评估了孟加拉国受心脏病影响的家庭的财务风险保护(FRP)。在全球心血管疾病激增的背景下（特别是在中低收入国家），孟加拉国的心脏病负担不断加重，过度依赖自付(OOP)医疗费用。我们的研究结果显示，受心脏病影响的家庭每年的自付费用大幅增加，从2005年的307.4美元增加到2010年的346.1美元，然后在2016年飙升至650.5美元。同时，灾难性的医疗支出(CHE)和贫困发生率上升，分别为2005年的17.6%到2010年的18.2%再到2016年的29.3%，以及2005年的3.2%到2010年的2.2%再到2016年的3.3%，这些数字在2010年后明显增加。这些费用和CHE发病率始终高于患有任何轻病的家庭，强调了FRP的差异，尤其是在经济弱势、农村家庭和由“没有受过正规教育的个人”担任户主的家庭中。本研究首次使用全面的国家数据，对孟加拉国针对心脏病的FRP动态进行分析，为相关文献作贡献。本研究揭示了受影响家庭FRP状况的不断恶化，并强调需要采取有针对性的干预措施来提高FRP，特别是在最脆弱的群体中。此外，本研究还强调了战略性公共卫生投资对减轻心脏病护理的财务影响的重要性，提供了适用于全球类似情况的见解。
Resumen Este estudio evalúa la protección contra el riesgo financiero (PRF) de los hogares afectados por enfermedades cardíacas en Bangladesh mediante el análisis de tres rondas de datos de la Encuesta de ingresos y gastos de los hogares (2005, 2010, and 2016). En medio de un aumento global de las enfermedades cardiovasculares, en particular en los países de ingresos bajos y medios, Bangladesh enfrenta una carga creciente de enfermedades cardíacas, con una dependencia excesiva de los gastos de atención médica de bolsillo. Nuestros hallazgos revelan un aumento sustancial en el gasto de OOP anual para hogares afectados por enfermedades cardíacas, de USD 307,40 en 2005 a USD 346,10 en 2010, y luego aumentó a USD 650,50 en 2016. Al mismo tiempo, las incidencias de gastos catastróficos de salud (CHE) y empobrecimiento aumentaron (17,6% a 18,2% a 29,3% y 3,2% a 2,2% a 3,3%, respectivamente), con un aumento notable después de 2010. Estos gastos e incidencias de CHE fueron consistentemente más altos que aquellos en hogares con cualquier dolencia, lo que subraya una disparidad en FRP, especialmente entre los hogares económicamente desfavorecidos, rurales y aquellos encabezados por personas sin educación formal. El estudio contribuye a la literatura al proporcionar un análisis por primera vez de la dinámica de FRP contra la enfermedad cardíaca en Bangladesh utilizando datos nacionales integrales. El informe revela el deterioro de la situación de la salud pública en los hogares afectados y destaca la necesidad de realizar intervenciones específicas para mejorar la salud pública, en particular entre los grupos más vulnerables. Además, destaca la importancia de realizar inversiones estratégicas en salud pública para mitigar las repercusiones financieras de la atención de las enfermedades cardíacas, y ofrece información que se puede aplicar a nivel mundial en contextos similares.
Key points Bangladesh, a country heavily reliant on out‐of‐pocket sources to finance health‐care expenses, grapples with a high burden of cardiovascular diseases, with approximately 275,000 deaths (30%) and 6.2 million disability‐adjusted life years lost annually. This study is the first to examine the levels and distributions of financial risk protection (FRP) among heart disease‐affected households in Bangladesh on a nationally representative scale. This study reveals a stark increase in annual out‐of‐pocket spending for households affected by heart disease, particularly after 2010. Although the proportion of heart disease affected households who were further impoverished decreased, the number of individuals pushed deeper into poverty due to households' out‐of‐pocket expenses increased. Heart disease‐affected households' out‐of‐pocket expenses and catastrophic health expenditure (CHE) incidences were consistently higher than those among households with any disease. Despite the second quintile of heart disease‐affected households experiencing the fastest deterioration in FRP status, the lowest quintile remained the least protected during the study period, experiencing disproportionately higher CHE and impoverishment than the wealthiest quintile. Rural households' FRP status was also consistently poorer than urban families. Findings underscore the need for targeted interventions and strategies, explicitly focusing on the most vulnerable, to improve FRP among households with heart disease, thereby enhancing the overall FRP status of the country.