65% of healthcare needs unmet as out-of-pocket costs soar: BIDS

Nearly two-thirds of Bangladeshis who needed healthcare in 2024 could not access it, largely because of high out-of-pocket costs, according to a study by the Bangladesh Institute of Development Studies (BIDS).

The study, presented at the institute’s office in Dhaka yesterday, found that 22 percent of the population reported a monthly need for healthcare. Of them, 15 percent experienced unmet need, equivalent to over 65 percent of total need going unaddressed.

Unmet need was higher in rural areas (68 percent) than in urban areas (59 percent). By district, it was highest in Narail (81 percent) and Habiganj (80 percent), and lowest in Feni (18 percent).

Out-of-pocket costs refer to what patients pay directly from their own money, not covered by insurance or government programmes, including fees, medicines, and diagnostic tests.

The study says that such expenditure on healthcare has risen “alarmingly” in Bangladesh, from 55.9 percent in 1997 to 68.5 percent in 2020, and now stands at 79.3 percent -- the highest in South Asia.

By comparison, the figure is 59 percent in Nepal, 54 percent in Sri Lanka, 52.9 percent in Pakistan, 43.9 percent in India, 25.5 percent in Bhutan, and 18 percent in the Maldives.

The study found that on average, Bangladeshi households spent Tk 3,454 per month on healthcare in 2024, accounting for 11 percent of total household expenditure. Medicines and diagnostic services were the largest cost drivers.

The study drew on data from the Household Income and Expenditure Survey (HIES) 2022, covering 14,400 households and 62,387 individuals.

Public healthcare facilities served patients across income groups more equitably, while private facilities were disproportionately used by wealthier households, said Abdur Razzaque Sarker, senior research fellow at BIDS, who presented the findings.

The financial burden fell hardest on the poor, he said, stating that the poorest households spent 35 percent of their income on healthcare, against 5 percent for the richest.

“This indicates that the healthcare system in Bangladesh is regressive,” he said.

“Out-of-pocket spending should be contained within 30-35 percent,” the researcher also said, adding that the government needs effective policies to implement a social health insurance scheme toward universal health coverage.

Prof Wahiduddin Mahmud, former planning adviser to the interim government, criticised the Ministry of Health for failing to understand actual demand and execute projects.

“Even though the budget for health is relatively small, the authorities are often unable to spend it. This indicates a profound lack of institutional capacity,” he said.

Prof Rashed Al Mahmud Titumir, the prime minister’s adviser on finance and planning, said the government views healthcare not merely as a service but as a fundamental right.

“While there is often a trade-off in resource allocation, our rights-based approach compels us to prioritise essential care,” he said.

According to him, the government is considering mandating at least three critical services across all 250-bed hospitals: cardiac coronary units (CCUs) to address rising heart-related emergencies, kidney dialysis to ensure accessible treatment for chronic kidney diseases, and complex gynaecological and obstetric care to safeguard maternal health.

“To prevent waste and enhance efficiency, we are introducing the e-Health Card project. Digitalising health records will streamline service delivery,” the PM’s adviser also said.

Nutrition programmes are also central to the government’s strategy, as unaddressed deficiencies place the wider healthcare system under continued strain, he added.