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Published (Version of Record)CC BY-NC V4.0, Open Access
Journal article
Crowding-out and crowding-in effects of out-of-pocket expenditures for non-communicable diseases care on household consumption patterns in Bangladesh: a cross-sectional analysis of the 2022 household income and expenditure survey
BMJ open, Vol.15(10), e098791
2025
PMID: 41130678
Abstract
This study aims to analyse the crowding-out and crowding-in effects of non-communicable diseases (NCDs) related out-of-pocket (OOP) health expenditures on household consumption in Bangladesh.
Design
This study used data from the nationally representative Bangladesh household income and expenditure survey (HIES) 2022.
Setting
Eight divisions of Bangladesh.
Participants
14 395 households.
Primary and secondary outcome measures
We examined how household consumption patterns across 20 expenditure categories were impacted by OOP health spending for NCD management, with a focus on income-level disparities.
Results
In Bangladesh, OOP health expenditures for NCDs crowded out household expenditures on essential items like food and rent. Across all households, OOP health expenditures for NCDs by 10 US$ crowded out −3.8 US$ of expenditure on food (95% CI −5.1 to –2.5), and more specifically on protein-rich foods (−2.0 US$, 95% CI −2.8 to –1.2), spices (−0.2 US$, 95% CI −0.3 to –0.1), and restaurant and café meals (−0.9 US$, 95% CI −1.4 to –0.5). Crowding-out was also seen for tobacco, rent, durable goods and miscellaneous. In lower-income households, expenditures on food (−4.1 US$, 95% CI −7.2 to –1.1), restaurant and café meals (−2.0 US$, 95% CI −3.1 to –0.8), spices (−0.4 US$, 95% CI −0.7 to –0.09), and rent (−3.1 US$, 95% CI −4.5 to –1.6) were significantly crowded out.
Conclusion
This research demonstrates that NCD-related spending in Bangladesh reduces budgets for both food and non-food expenditures, with a stronger crowding-out effect on food items and rent, particularly in lower-income households. Effective financial and social protection mechanisms against NCDs are warranted to safeguard the consumption of the NCD-affected households in Bangladesh.
Details
- Title
- Crowding-out and crowding-in effects of out-of-pocket expenditures for non-communicable diseases care on household consumption patterns in Bangladesh: a cross-sectional analysis of the 2022 household income and expenditure survey
- Authors/Creators
- Md Tauhidul Islam - Murdoch UniversityAdelakun Odunyemi - Murdoch UniversityMieghan Bruce - Murdoch UniversityKhurshid Alam - Murdoch University
- Publication Details
- BMJ open, Vol.15(10), e098791
- Publisher
- British Medical Journal Publishing Group
- Number of pages
- 10
- Grant note
- Murdoch University (http://dx.doi.org/10.13039/501100001799)
- Identifiers
- 991005823436507891
- Copyright
- © Author(s) (or their employer(s)) 2025.
- Murdoch Affiliation
- Centre for Biosecurity and One Health; Murdoch Business School; Ngangk Yira Institute for Change; Centre for Healthy Ageing; School of Veterinary Medicine; Personalised Medicine Centre
- Language
- English
- Resource Type
- Journal article
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- Citation topics
- 1 Clinical & Life Sciences
- 1.156 Healthcare Policy
- 1.156.381 Maternal Health Equity
- Web Of Science research areas
- Public, Environmental & Occupational Health
- ESI research areas
- Clinical Medicine