65% of healthcare needs still unmet, poor spend one-third income on treatment: Study
It found households spend an average Tk3,454 per month on healthcare, or 11% of total expenditure, with medicines and diagnostic services as the main cost drivers.
Highlights
- 22% of population requires monthly healthcare services
- Rural unmet need (68%) higher than urban (59%)
- Medicines and diagnostic services driving major costs
- Rich spend 5% income on healthcare, poor households spend 35%
Poor households in Bangladesh spend nearly 35% of their income on healthcare, while nearly 65% of national healthcare needs still go unmet, exposing deep inequality in access and affordability, according to a study presented at the Bangladesh Institute of Development Studies (BIDS) today (7 May).
The study, "Re-thinking Unmet Healthcare Needs and Dynamics of Out-of-Pocket (OOP) Expenditure in Bangladesh", was conducted by BIDS Senior Research Fellow Abdur Razzaque Sarker using data from the 2022 Household Income and Expenditure Survey covering 14,400 households and 62,387 individuals.
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It found households spend an average Tk3,454 per month on healthcare, or 11% of total expenditure, with medicines and diagnostic services as the main cost drivers.
Out-of-pocket (OOP) expenditure accounted for 79% of total health spending in 2024, making it the dominant financing source and a key driver of financial strain in the health system.
The burden is significantly skewed toward lower-income groups. The study found the poorest households spend nearly 35% of their income on healthcare, compared to only 5% among the richest, describing the system as regressive and inequality-driving despite higher absolute spending among richer groups.
The study also found that around 22% of the population requires healthcare services monthly, but access gaps remain wide, with 15% of the population facing unmet healthcare needs – nearly 65% of those needing treatment – indicating substantial service shortfalls.
Rural areas are more affected, with unmet healthcare needs at 68%, compared to 59% in urban areas. District-level disparities are also significant, with Narail recording the highest unmet need at 81%, followed by Habiganj at 80%, while Feni reported the lowest at 18%.
Chairing the seminar, economist and former Planning Ministry adviser Professor Wahiduddin Mahmud said unmet healthcare demand remains a major challenge.
"Many people avoid necessary treatment due to ignorance, indifference and lack of awareness," he said, adding that ensuring services alone is not enough unless people are encouraged to seek care.
He also pointed to regional disparities, noting low utilisation in Sylhet despite better infrastructure, while Faridpur shows higher utilisation despite weaker facilities, influenced by social conservatism and women's empowerment.
Warning that rising out-of-pocket expenditure is widening inequality, he said higher-income groups can access care more easily while poorer groups fall behind. He added that limited resources force difficult policy choices between investing in primary healthcare and expanding costly advanced services such as ICU and dialysis.
Speaking as the chief guest, Prime Minister's Adviser on the Planning and Finance Ministries Professor Rashed Al Mahmud Titumir said the government plans to establish a life-cycle-based social protection system covering citizens from birth to death.
He said the plan includes increased primary healthcare funding, stronger disease prevention and awareness programmes, recruitment of 100,000 health workers, and raising healthcare allocation to 5% of GDP to reduce inequality.
