Financial risk protection against ill health in low- and middle-income countries: a case of Bangladesh

Taslima Rahman

Ensuring financial risk protection (FRP) against ill health is central to achieving the Sustainable Development Goals' Universal Health Coverage (UHC) target by 2030. Bangladesh, a lower-middle-income country, has committed to achieving UHC. However, despite commendable economic growth, the country's high out-of-pocket payment share in total healthcare expenditure and the increasing noncommunicable disease (NCD) burden challenge FRP and UHC attainment. This thesis reviews the recent FRP literature in low- and middle-income countries (LMICs) to summarize existing evidence and identify evidence gaps. To address the gaps, it examines the levels, distributions, and evolution of (the lack) of FRP against illness, including NCDs and heart disease, in Bangladesh using the latest nationally representative data (2005, 2010, and 2016 rounds), employing refined methodologies. The scoping review, including 155 LMIC studies, finds a narrow conceptualization of FRP and absolute dependency on FRP measurement methods with limited equity implications. Empirical studies in Bangladesh suggest a deterioration of FRP, specifically in 2016 (e.g., catastrophic healthcare expenditure incidence (CHE): 11.5% in 2005, 11.9% in 2010, and 16.6% in 2016). FRP was disproportionately lower among households with NCDs than without NCDs. Heart disease-affected households' lack of FRP was especially notable. The lowest quintile households were invariably the least protected in all analyses. Also, the ruralurban disparity in FRP widened over time, with rural-urban differences in household economic status, household head education, healthcare sources and chronic illness prevalence contributing significantly to higher CHE among rural households. The findings underscore an urgent need for targeted interventions to improve healthcare financing and ensure FRP in Bangladesh, prioritizing vulnerable populations, including lowincome and rural households and those afflicted by NCDs, including heart disease. This study contributes to the broader LMIC literature on equity in FRP and offers insights for policymakers in Bangladesh and other LMICs with similar healthcare financing structures and disease profiles.

Financial risk protection against ill health in low- and middle-income countries: a case of Bangladesh

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