Abstract
BACKGROUND: Out-of-pocket (OOP) expenditure is one of the most common payment strategies for hospitalization care in Bangladesh, and the share of OOP expenditure has been increasing at an alarming rate. This study aimed to investigate the OOP costs of hospitalization care, the impact of OOP on catastrophic healthcare expenditure (CHE) and financial distress, and the associated factors. METHODS: We used data from the most recent nationally representative dataset, the Bangladesh Household Income and Expenditure Survey 2022. A total of 14,395 households were surveyed, with 1973 household members hospitalized due to various illnesses. Respondents were asked to provide information regarding hospitalization care for the year preceding the survey. Households were considered to have CHE if they spent at least 25% of their total consumption expenditure or 40% of their non-food consumption expenditure on healthcare. Distress financing was defined as covering OOP healthcare costs by selling assets, borrowing money, or receiving financial assistance from friends or relatives. Multivariate logistic regression models were used to identify the determinants of CHE and distress financing. RESULTS: The annual average OOP cost of hospitalization was USD 418, with the OOP cost nearly twice as high in private facilities compared to public ones (USD 538 vs. USD 283). The highest OOP costs were observed for cancer treatment (USD 2365), followed by COVID-19 (USD 1391). Overall, 6.72% and 9.03% of hospitalized patients experienced CHE at 25% of total expenditure and 40% of non-food expenditure, respectively, while about 61% of patients faced distress financing due to hospitalization. CONCLUSION: Financial hardship due to hospitalization remains high in Bangladesh. These findings will help policymakers adopt more effective healthcare financing strategies and improve the efficiency of public health investments.