Journal article
Rural‒urban disparities in household catastrophic health expenditure in Bangladesh: a multivariate decomposition analysis
International Journal for Equity in Health, Vol.23, 43
2024
Abstract
Background Rural‒urban disparity in catastrophic healthcare expenditure (CHE) is a well-documented challenge in low-and middle-income countries, including Bangladesh, limiting financial protection and hindering the achievement of the Universal Health Coverage target of the United Nations Sustainable Development Goals. However, the factors driving this divide remain poorly understood. Therefore, this study aims to identify the key determinants of the rural‒urban disparity in CHE incidence in Bangladesh and their changes over time. Methods We used nationally representative data from the latest three rounds of the Bangladesh Household Income and Expenditure Survey (2005, 2010, and 2016). CHE incidence among households seeking healthcare was measured using the normative food, housing, and utilities method. To quantify covariate contributions to the rural‒urban CHE gap, we employed the Oaxaca-Blinder multivariate decomposition approach, adapted by Powers et al. for nonlinear response models. Results CHE incidence among rural households increased persistently during the study period (2005: 24.85%, 2010: 25.74%, 2016: 27.91%) along with a significant (p-value ≤ 0.01) rural‒urban gap (2005: 9.74%-points, 2010: 13.94%-points, 2016: 12.90%-points). Despite declining over time, substantial proportions of CHE disparities (2005: 87.93%, 2010: 60.44%, 2016: 61.33%) are significantly (p-value ≤ 0.01) attributable to endowment differences between rural and urban households. The leading (three) covariate categories consistently contributing significantly (p-value ≤ 0.01) to the CHE gaps were composition disparities in the lowest consumption quintile (2005: 49.82%, presence of chronic illnesses in households emerged as a significant factor in 2016 (9.14%, p-value ≤ 0.01), superseding the contributions of composition differences in household heads with no education (4.40%, p-value ≤ 0.01) and secondary or higher education (7.44%, p-value ≤ 0.01), which were the fourth and fifth significant contributors in 2005 and 2010. Conclusions Rural‒urban differences in household economic status, educational attainment of household heads, and healthcare sources were the key contributors to the rural‒urban CHE disparity between 2005 and 2016 in Bangla-desh, with chronic illness emerging as a significant factor in the latest period. Closing the rural‒urban CHE gap necessitates strategies that carefully address rural‒urban variations in the characteristics identified above.
Details
- Title
- Rural‒urban disparities in household catastrophic health expenditure in Bangladesh: a multivariate decomposition analysis
- Authors/Creators
- Taslima RahmanDomenico GasbarroKhorshed Alam - University of Southern QueenslandKhurshid K Alam (Author) - Murdoch University, Centre for Healthy Ageing
- Publication Details
- International Journal for Equity in Health, Vol.23, 43
- Publisher
- BioMed Central Ltd unless otherwise stated. Part of Springer Nature.
- Identifiers
- 991005638767107891
- Copyright
- © 2024 BioMed Central Ltd unless otherwise stated. Part of Springer Nature
- Murdoch Affiliation
- Centre for Healthy Ageing; Centre for Molecular Medicine and Innovative Therapeutics; Ngangk Yira Institute for Change
- Language
- English
- Resource Type
- Journal article
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