Pathways to Reduce Household Out-of-Pocket Expenditure
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World Bank, Washington, DC
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Bangladesh allocates a much smaller
share of the government budget to health than countries of
similar income level. Reallocation is politically
challenging but could offer the biggest potential source of
fiscal space for health, larger than the space that economic
growth can bring. How those additional resources are used,
is also important to improve financial protection. Improving
the readiness of the public health care network to provide
quality care, particularly at primary health care level,
could reduce the use of alternative providers, thereby
reducing the need for OOP payments. Ensuring the
functionality of community clinics, union level facilities,
and upazila health complexes, including a revision of their
opening hours would also contribute towards this goal.
Ensuring access to pharmaceutical products, particularly for
essential NCD-related drugs, at affordable prices could also
contribute to a reduction in households OOP payments. In
addition to these supply-side interventions, the government
could consider demand-side programs where resources follow
the patient. For instance, given the large needs and the
little resources available, an important pathway to reduce
OOP payments while decreasing inequalities would be better
targeting public subsidies to the poor and vulnerable.
Finally, improving public financial management, policies,
and governance will also contribute to the effective use of
existing and any additional resources for health.
Palabras clave
HEALTH SPENDING, FINANCIAL PROTECTION, DOMESTIC RESOURCE MOBILIZATION, OUT-OF-POCKET EXPENSE, HEALTH COST, PUBLIC EXPENDITURE, POOLED FUNDS, PUBLIC FINANCIAL MANAGEMENT