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Healthcare-Seeking Behavior and Out-of-Pocket Payments in Rural Bangladesh: A Cross-Sectional Analysis

Received: 25 July 2018     Accepted: 28 August 2018     Published: 28 September 2018
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Abstract

This study investigates the determinants of patient’s choice of treatment (i.e., modern vs. alternative healthcare) using Bangladesh’s Household Income and Expenditure Survey (HIES) dataset for exploring their healthcare-seeking behavior and the extent of out-of-pocket (OOP) payment due to illnesses. It explores this issues using the descriptive statistics, bivariate analysis like analysis of variance (ANOVA) and Chi-square test as well as econometric modeling (probit regression model on modern healthcare utilization for the full sample as well as for each quintile). All these help to identify the determinants of healthcare-seeking behavior in rural Bangladesh and how these vary across the quintiles of expenditure on food consumption. This study finds that higher percentage of healthcare-seeking patients receives alternative healthcare because of the lower cost and easier access compared to modern healthcare. The marginal effects of the predisposing factors like patient’s age, parent’s literacy, mother’s age, house with separate dining room, access to electricity and mobile are significantly positive, which means these are more likely to influence modern healthcare utilization. In contrast, the marginal effects of the enabling factors like income, landholdings, access to social benefit are positive, but insignificant. Therefore, predisposing factors rather than enabling factors play crucial role in determining choice of modern treatment in rural Bangladesh. In addition, variations in the marginal effects exist across different groups based on regression by quintile. Finally, sickness prevalence as well as modern healthcare utilization also varies across geographic regions. The average OOP payment is higher for modern healthcare compared to alternative one and it remains true after disaggregation of OOP expenditure. Disease-specific OOP using first-difference method is also positive for all diseases (i.e., OOP expenditure for modern healthcare> OOP expenditure for alternative healthcare) and most of the first-difference estimates are statistically significant. Similar tendencies are also observed in case of applying distributional analysis using quintiles. All these are important for formulating a national health policy for the rural people in Bangladesh. At last, a special attention to expanding utilization of modern healthcare is required for young mothers, elderly household head and the patients belong to minority group in rural Bangladesh.

Published in Psychology and Behavioral Sciences (Volume 7, Issue 3)
DOI 10.11648/j.pbs.20180703.12
Page(s) 45-55
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Healthcare-Seeking Behaviour, Predisposing and Enabling Factors, OOP, Rural Bangladesh

References
[1] Gwatkin, D. R., Rutstein, S., Johnson, K., Suliman, E., Wagstaff, A., & Amouzou, A. (2007). Socio-economic differences in health, nutrition, and population within developing countries. Washington, DC: World Bank, 287.
[2] Gwatkin, D. R., Bhuiya, A., & Victora, C. G. (2004). Making health systems more equitable. The Lancet, 364(9441), 1273-1280.
[3] Victora, C. G., Wagstaff, A., Schellenberg, J. A., Gwatkin, D., Claeson, M., & Habicht, J. P. (2003). Applying an equity lens to child health and mortality: more of the same is not enough. The Lancet, 362(9379), 233-241.
[4] Wagstaff, A. (2002). Poverty and health sector inequalities. Bulletin of the world health organization, 80, 97-105.
[5] Ahmed, S. M. (2009). Capability development among the ultra-poor in Bangladesh: a case study. Journal of health, population, and nutrition, 27(4), 528.
[6] Ahmed, S. M., Alam, B. B., Anwar, I., Begum, T., Huque, R., & Khan, J. A. (2017). Bangladesh health SystemReview: health Systems in Transition.
[7] World Health Organisation (2015). Bangladesh: Health profile.
[8] Government of Bangladesh (2016). Health, nutrition and population strategic investment plan. Ministry of Health and Family Welfare, Dhaka, Bangladesh.
[9] Amin, R. (2007). Grameen Micro-credit to Grameen Kalyan Health Program for the Poor, Reasons for Optimism. Academic Press and Publishers Library.
[10] Rahman, M. H., Mosley, W. H., Ahmed, S., & Akhter, H. H. (2008). Does service accessibility reduce socioeconomic differentials in maternity care seeking? Evidence from rural Bangladesh. Journal of biosocial science, 40(1), 19-33.
[11] Amin, R., Shah, N. M., & Becker, S. (2010). Socioeconomic factors differentiating maternal and child health-seeking behavior in rural Bangladesh: A cross-sectional analysis. International journal for equity in health, 9(1), 9.
[12] Karim, F., Tripura, A., Gani, M. S., & Chowdhury, A. M. R. (2006). Poverty status and health equity: evidence from rural Bangladesh. Public health, 120(3), 193-205.
[13] Yunus, M. (2004). Grameen Bank, microcredit and millennium development goals. Economic and Political Weekly, 4077-4080.
[14] Ahmed, S. M., Adams, A. M., Chowdhury, M., & Bhuiya, A. (2000). Gender, socioeconomic development and health-seeking behaviour in Bangladesh. Social science & medicine, 51(3), 361-371.
[15] Ahmed, S. M., Petzold, M., Kabir, Z. N., & Tomson, G. (2006). Targeted intervention for the ultra poor in rural Bangladesh: Does it make any difference in their health-seeking behaviour?. Social science & medicine, 63(11), 2899-2911.
[16] Koenig, M. A., Jamil, K., Streatfield, P. K., Saha, T., Al-Sabir, A., Arifeen, S. E.,... & Haque, Y. (2007). Maternal health and care-seeking behavior in Bangladesh: findings from a national survey. International family planning perspectives, 75-82.
[17] Arifeen, S. E., Bryce, J., Gouws, E., Baqui, A. H., Black, R. E., Hoque, D. M. E.,... & Siddique, A. (2005). Quality of care for under-fives in first-level health facilities in one district of Bangladesh. Bulletin of the World Health Organization, 83, 260-267.
[18] Chakraborty, N., Islam, M. A., Chowdhury, R. I., Bari, W., & Akhter, H. H. (2003). Determinants of the use of maternal health services in rural Bangladesh. Health promotion international, 18(4), 327-337.
[19] Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter?. Journal of health and social behavior, 1-10.
[20] Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly. Health and Society, 95-124.
[21] Kroeger, A. (1983). Anthropological and socio-medical health care research in developing countries. Social science & medicine, 17(3), 147-161.
[22] Carmel, S. (1990). The Health Belief Model in the research of AIDS-related preventive behavior. Public health reviews, 18(1), 73-85.
[23] Rahman, H. Z., & Hossain, M. (1992). Rethinking rural poverty: a case for Bangladesh. Dhaka: Bangladesh Institute of Development Studies.
[24] Chrisman, N. J. (1977). The health seeking process: an approach to the natural history of illness. Culture, medicine and psychiatry, 1(4), 351-377.
[25] Ward, H., Mertens, T. E., & Thomas, C. (1997). Health seeking behaviour and the control of sexually transmitted disease. Health Policy and planning, 12(1), 19-28.
[26] Zola, I. K. (1966). Culture and symptoms--an analysis of patient's presenting complaints. American sociological review, 615-630.
[27] Helman, C. G. (1995). The body image in health and disease: exploring patients' maps of body and self. Patient Education and Counseling, 26(1), 169-175.
[28] Kleinman, A., & Gale, J. L. (1982). Patients treated by physicians and folk healers: a comparative outcome study in Taiwan. Culture, medicine and psychiatry, 6(4), 405-423.
[29] Timyan, J., SJ, G. B., Measham, D. M., & Ogunleye, B. (1993). Access to care: more than a problem of distance.
[30] Chaudhury, N., & Hammer, J. (2003). Ghost doctors: absenteeism in Bangladeshi health facilities. The World Bank.
[31] Jahan, R. (2007). Securing maternal health through comprehensive reproductive health services: lessons from Bangladesh. American journal of public health, 97(7), 1186-1190.
[32] Anwar, A. T., Killewo, J., Chowdhury, M. K., & Dasgupta, S. (2005). Bangladesh: Inequalities in utilization of maternal health care services-Evidence from Matlab. Reaching the poor with health, nutrition, and population services—what works, what doesn’t, and why. Washington, DC: World Bank, 117-36.
[33] Perry, H. B. (2000). Health for all in Bangladesh: lessons in primary health care for the twenty-first century. University Press.
[34] Sen, B., & Begum, S. (1998). Methodology for identifying the poorest at local level. In Macroeconomics: Health and Development Series.
[35] Ensor, T., Dave-Sen, P., Ali, L., Hossain, A., Begum, S. A., & Moral, H. (2002). Do essential service packages benefit the poor? Preliminary evidence from Bangladesh. Health Policy and Planning, 17(3), 247-256.
[36] Wong, E. L., Popkin, B. M., Guilkey, D. K., & Akin, J. S. (1987). Accessibility, quality of care and prenatal care use in the Philippines. Social Science & Medicine, 24(11), 927-944.
[37] Becker, S., Peters, D. H., Gray, R. H., Gultiano, C., & Black, R. E. (1993). The determinants of use of maternal and child health services in Metro Cebu, the Philippines. Health transition review, 77-89.
[38] Kleinman, A. (1980). Patiens and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley: University of California Press.
[39] Fosu, G. B. (1994). Childhood morbidity and health services utilization: cross-national comparisons of user-related factors from DHS data. Social science & medicine, 38(9), 1209-1220.
[40] Costello, M. A., Lleno, L. C., & Jensen, E. R. (1996). Determinants of two major early-childhood diseases and their treatment in the Philippines: findings from the 1993 National Demographic Survey. Asia-Pacific population research abstracts, (9), 1-2.
[41] Waldron, I. (1982). An analysis of causes of sex differences in mortality and morbidity. The fundamental connection between nature and nurture, 69-116.
[42] Gotsadze, G., Bennett, S., Ranson, K., & Gzirishvili, D. (2005). Health care-seeking behaviour and out-of-pocket payments in Tbilisi, Georgia. Health policy and planning, 20(4), 232-242.
[43] Murray, C. J., & Chen, L. C. (1992). Understanding morbidity change. The Population and Development Review, 481-503.
[44] SIAPS (2015). Baseline Study of Private Drug Shops in Bangladesh: Findings and Recommendations. US Agency for International Development. Arlington, VA: Management Sciences for Health.
[45] Mannan, M. A. (1990). Mother and child health in Bangladesh: evidence from field data.
[46] Stock, R. (1983). Distance and the utilization of health facilities in rural Nigeria. Social science & medicine, 17(9), 563-570.
[47] Paul, B. K. (1991). Health service resources as determinants of infant death in rural Bangladesh: an empirical study. Social science & medicine, 32(1), 43-49.
[48] Roberts, R. E. (1983). Medical Choice in a Mexican Village.
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  • APA Style

    Muhammad Shahadat Hossain Siddiquee, Amin Masud Ali. (2018). Healthcare-Seeking Behavior and Out-of-Pocket Payments in Rural Bangladesh: A Cross-Sectional Analysis. Psychology and Behavioral Sciences, 7(3), 45-55. https://doi.org/10.11648/j.pbs.20180703.12

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    ACS Style

    Muhammad Shahadat Hossain Siddiquee; Amin Masud Ali. Healthcare-Seeking Behavior and Out-of-Pocket Payments in Rural Bangladesh: A Cross-Sectional Analysis. Psychol. Behav. Sci. 2018, 7(3), 45-55. doi: 10.11648/j.pbs.20180703.12

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    AMA Style

    Muhammad Shahadat Hossain Siddiquee, Amin Masud Ali. Healthcare-Seeking Behavior and Out-of-Pocket Payments in Rural Bangladesh: A Cross-Sectional Analysis. Psychol Behav Sci. 2018;7(3):45-55. doi: 10.11648/j.pbs.20180703.12

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  • @article{10.11648/j.pbs.20180703.12,
      author = {Muhammad Shahadat Hossain Siddiquee and Amin Masud Ali},
      title = {Healthcare-Seeking Behavior and Out-of-Pocket Payments in Rural Bangladesh: A Cross-Sectional Analysis},
      journal = {Psychology and Behavioral Sciences},
      volume = {7},
      number = {3},
      pages = {45-55},
      doi = {10.11648/j.pbs.20180703.12},
      url = {https://doi.org/10.11648/j.pbs.20180703.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.pbs.20180703.12},
      abstract = {This study investigates the determinants of patient’s choice of treatment (i.e., modern vs. alternative healthcare) using Bangladesh’s Household Income and Expenditure Survey (HIES) dataset for exploring their healthcare-seeking behavior and the extent of out-of-pocket (OOP) payment due to illnesses. It explores this issues using the descriptive statistics, bivariate analysis like analysis of variance (ANOVA) and Chi-square test as well as econometric modeling (probit regression model on modern healthcare utilization for the full sample as well as for each quintile). All these help to identify the determinants of healthcare-seeking behavior in rural Bangladesh and how these vary across the quintiles of expenditure on food consumption. This study finds that higher percentage of healthcare-seeking patients receives alternative healthcare because of the lower cost and easier access compared to modern healthcare. The marginal effects of the predisposing factors like patient’s age, parent’s literacy, mother’s age, house with separate dining room, access to electricity and mobile are significantly positive, which means these are more likely to influence modern healthcare utilization. In contrast, the marginal effects of the enabling factors like income, landholdings, access to social benefit are positive, but insignificant. Therefore, predisposing factors rather than enabling factors play crucial role in determining choice of modern treatment in rural Bangladesh. In addition, variations in the marginal effects exist across different groups based on regression by quintile. Finally, sickness prevalence as well as modern healthcare utilization also varies across geographic regions. The average OOP payment is higher for modern healthcare compared to alternative one and it remains true after disaggregation of OOP expenditure. Disease-specific OOP using first-difference method is also positive for all diseases (i.e., OOP expenditure for modern healthcare> OOP expenditure for alternative healthcare) and most of the first-difference estimates are statistically significant. Similar tendencies are also observed in case of applying distributional analysis using quintiles. All these are important for formulating a national health policy for the rural people in Bangladesh. At last, a special attention to expanding utilization of modern healthcare is required for young mothers, elderly household head and the patients belong to minority group in rural Bangladesh.},
     year = {2018}
    }
    

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  • TY  - JOUR
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    AU  - Muhammad Shahadat Hossain Siddiquee
    AU  - Amin Masud Ali
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    PB  - Science Publishing Group
    SN  - 2328-7845
    UR  - https://doi.org/10.11648/j.pbs.20180703.12
    AB  - This study investigates the determinants of patient’s choice of treatment (i.e., modern vs. alternative healthcare) using Bangladesh’s Household Income and Expenditure Survey (HIES) dataset for exploring their healthcare-seeking behavior and the extent of out-of-pocket (OOP) payment due to illnesses. It explores this issues using the descriptive statistics, bivariate analysis like analysis of variance (ANOVA) and Chi-square test as well as econometric modeling (probit regression model on modern healthcare utilization for the full sample as well as for each quintile). All these help to identify the determinants of healthcare-seeking behavior in rural Bangladesh and how these vary across the quintiles of expenditure on food consumption. This study finds that higher percentage of healthcare-seeking patients receives alternative healthcare because of the lower cost and easier access compared to modern healthcare. The marginal effects of the predisposing factors like patient’s age, parent’s literacy, mother’s age, house with separate dining room, access to electricity and mobile are significantly positive, which means these are more likely to influence modern healthcare utilization. In contrast, the marginal effects of the enabling factors like income, landholdings, access to social benefit are positive, but insignificant. Therefore, predisposing factors rather than enabling factors play crucial role in determining choice of modern treatment in rural Bangladesh. In addition, variations in the marginal effects exist across different groups based on regression by quintile. Finally, sickness prevalence as well as modern healthcare utilization also varies across geographic regions. The average OOP payment is higher for modern healthcare compared to alternative one and it remains true after disaggregation of OOP expenditure. Disease-specific OOP using first-difference method is also positive for all diseases (i.e., OOP expenditure for modern healthcare> OOP expenditure for alternative healthcare) and most of the first-difference estimates are statistically significant. Similar tendencies are also observed in case of applying distributional analysis using quintiles. All these are important for formulating a national health policy for the rural people in Bangladesh. At last, a special attention to expanding utilization of modern healthcare is required for young mothers, elderly household head and the patients belong to minority group in rural Bangladesh.
    VL  - 7
    IS  - 3
    ER  - 

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Author Information
  • Department of Economics, University of Dhaka, Dhaka, Bangladesh

  • Global Development Institute, the University of Manchester, Manchester, UK

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