More Than 10.8 Million People Pushed Below Poverty Line by Medical Costs in 2022: Health Economics Unit Study

People across the country are coming under growing financial pressure when they fall ill and seek treatment. Whether it is medicine, diagnostic tests, doctors' fees or hospital admission, families are having to pay out of their own pockets in every area. Savings are shrinking and financial uncertainty is rising. Many are even slipping below the poverty line while meeting the cost of treatment.

A study by the Health Economics Unit (HEU) of the health ministry has found that the average monthly medical spending of a family has risen about 2.6 times over the past 17 years. Over the same period, the share of people falling into financial hardship while bearing treatment costs has risen to 41.7 percent.

The study, titled 'Financial hardship caused by personal spending on healthcare in Bangladesh and the distribution of benefits of public healthcare', says that in 2022 more than 10.8 million people fell below the poverty line while meeting treatment costs. In 2005 the figure was about 5.6 million.

According to the study, the share of people pushed below the poverty line by medical spending reached 6.4 percent in 2022, up from 3.9 percent in 2005.

The study, conducted with support from the World Health Organization (WHO) and the Swedish Embassy, also says that while the country's overall poverty rate fell from 40 percent in 2005 to 18.7 percent in 2022, the share of people in financial hardship because of treatment costs rose from 28.2 percent to 41.7 percent. The global rate is 26 percent.

Even after adjusting for inflation, a family's average monthly medical spending rose from Tk 1,241 in 2005 to Tk 3,238 in 2022. Over this period, the share of families spending their own money on treatment rose from 52.5 percent to 92.7 percent.

The largest share of treatment spending goes on medicine. In 2022, 74 percent of the total spending of outpatient patients went on medicine. For hospital inpatients, the share spent on medicine was 35 percent. Diagnostic tests accounted for 11 percent of total treatment spending for outpatients and 22 percent for inpatients.

Reliance on pharmacies for outpatient care has also risen markedly. While 32.5 percent of such care was taken through pharmacies in 2016, the figure rose to 55.4 percent in 2022.

The study found that poor people face the greatest financial hardship in bearing treatment costs. In 2022, 90.8 percent of the poorest 20 percent of the population came under financial pressure because of medical spending. Among the richest 20 percent, the rate was 13.6 percent. In rural areas the rate was 47.9 percent, compared with 28.2 percent in urban areas.

Among the divisions, the situation is most alarming in Barisal. There, the share of people in financial hardship due to treatment costs rose from 22.5 percent in 2005 to 59.1 percent in 2022.

The study also shows a declining trend in the use of public healthcare. While 61.3 percent of hospital inpatients took treatment at public facilities in 2016, the figure fell to 56 percent in 2022. Treatment at private facilities, meanwhile, rose from 36.9 percent to 42.5 percent.

The study was prepared by analysing data from the Household Income and Expenditure Surveys of 2005, 2010, 2016 and 2022. The researchers say that although poor people need healthcare the most, the benefits of public health spending are not reaching them properly. To reduce the pressure of treatment costs, the research team recommended increasing public financing in the health sector, ensuring proper use of allocations, and making essential medicines and diagnostic tests easily available to poor people. It also stressed making treatment for long-term diseases affordable.

Public health specialist Professor Dr Mozammel Haque said that if treatment costs keep rising, poor and lower-middle-class families will be at the greatest risk. When individuals have to bear a large share of healthcare costs, illness becomes not only a health problem but also a cause of financial crisis. He stressed improving the quality of services at public hospitals, making essential medicines and tests easily available, and ensuring effective financial protection for poor people.

State Minister for Health M A Muhit said upazila health complexes are being modernised to reduce people's treatment costs. There is also a plan to recruit new health workers at union level. He said initiatives are being taken to deliver specialised treatment services free of charge or at low cost at district and divisional levels. At the same time, monitoring is being increased to control the quality of services at pharmacies, clinics and diagnostic centres.