Bangladesh’s households bear some 93 per cent of the total cost of illness for senior citizens as out-of-pocket payment, highest in South Asia, a new study finds.
The study, conducted by Bangladesh Institute of Development Studies (BIDS), has also revealed the majority of elderly people get healthcare services from pharmacies, indicating a hazardous scenario of the country’s health sector.
The study on ‘Health status and healthcare-seeking behaviour assessment among elderly citizens in Bangladesh’ found that approximately 93 per cent of elderly people suffered from illness in the last six months preceding the survey whereas 84 per cent suffered from chronic illness. The survey was completed on September 30, 2020.
Citing the WHO Global health expenditure database, Dr Abdur Razzaque Sarker, a research fellow of BIDS, said the overall out-of-pocket expenditure in the percentage of total health expenditure in Bangladesh is about 74 per cent of current healthcare expenditure, which is higher than those of any SAARC nations, except for Afghanistan.
Due to the lack of caregivers or attendants many households choose pharmacies due to various reasons such as proximity and cost-saving, he said.
Further, many drug sellers in Bangladesh inject IV or IM drug to the patients, measure blood pressure and measure glucose by portable machine and provide them medicine, he added.
This dependency increases out-of-pocket costs as inadequate treatment often leads to high morbidity and even deaths.
To avoid self-medication and unnecessary medical costs, the government needs to take educational and regulatory interventions to improve knowledge and professional behaviour of drug sellers along with consumers, Dr Sarker stated.
Terming health condition for the elderly people is critical and they suffered from several diseases for a longer time, the study, however, said elderly citizen often felt and suggested that the government should prioritise affordable care in public hospitals for the betterment of their health and wellbeing.
The majority of the elderly people reported that some 61 per cent have taken healthcare services from pharmacies, followed by public facilities (33 per cent) and private facilities (19 per cent).
They find that nearly 9.0 per cent of the elderly citizen in the poorest quintiles did not seek care while in the richest quintiles it was only 2.0 per cent.
Although the provision of basic health services is a constitutional obligation of the government, providing adequate care of the elderly is often a major challenge in Bangladesh, the study stressed.
The study concludes with the suggestion that the improvements to the elder-friendly health infrastructure are a necessary component for betterment the health of the elderly citizen.
Indeed, rapid population ageing combined with an increasing demand for healthcare with chronic disabilities have created an emerging research agenda as a means to inform policymaking.
These findings can be utilised further for designing financial risk protection schemes targeting elderly citizens, which is in line with the core objectives of the Healthcare Financing Strategy of Bangladesh to achieve the universal health coverage within 2032.
The community-based cross-sectional household survey was conducted in Tangail district.
A total of 478 households with at least one elder citizen (60 years or more) were surveyed between November 2019 and January 2020.
A total of 585 elderly individuals have been enrolled in the study while 49 per cent of the respondents have come from the urban area and the rest were from rural (51 per cent) areas.
The most of the elderly citizen was suffered from hypertension (15.6 per cent), gastric or ulcer (14.3 per cent), pain (13.6 per cent), diabetes (8.9 per cent), cardiac disease (7.6 per cent), weakness (6.8 per cent), asthma (5.0 per cent), flue/cough (3.7 per cent), arthritis (2.9 per cent) as well as eye-related infections (2.7 per cent).
Among all the sick elderly people, 95 per cent have taken healthcare services from various facilities.
The cost of acute illness and chronic illness was BDT 4,918 (SD± 9,948) and BDT 7,580 (SD± 31,765).
Approximately 59 per cent of the elder citizens reported that they had some or extreme health-related problems.
This poor health status is also reflected in their healthcare cost as per earlier study, the highest healthcare expenditure was observed among the aged population in Bangladesh, Dr Sarker said.
Universal social security programmes such as universal old-age pension, old age allowance could be initiated so that they could be anxieties and depressions-free in later life, Dr Abdur Razzaque said.
Social health insurance can therefore be viewed as an important component of financial protection as it aims to make healthcare affordable and accessible to all elder citizens, he added.