92% want more govt spending on healthcare to reduce out-of-pocket expenses: BBS survey
Bangladeshis bear 72.5% of their total healthcare expenses out of their own pockets
As the financial burden of healthcare continues to rise, 92.1% of Bangladeshis want an increased share of government expenditure to ease out-of-pocket costs, according to a recent survey by the Bangladesh Bureau of Statistics (BBS).
The survey conducted at the request of the Health Sector Reform Commission also found that 87.9% of Bangladeshis want the healthcare budget to be at least 5% of the GDP to ensure universal healthcare access.
Besides, 91.1% of Bangladeshis believe primary healthcare should be a constitutional right. It also revealed that 38% of people experienced negligence, poor care or malpractice while seeking treatment at hospitals.
According to World Health Organization (WHO) estimates for 2022, Bangladeshis bear 72.5% of their total healthcare expenses out of their own pockets. This burden has pushed 61 lakh people into poverty that year, according to the Bangladesh Institute of Development Studies (BIDS).
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Conducted in January and February 2025, the survey collected responses from 856 individuals across 344 sample areas in both urban and rural regions of all 64 districts in the country. Each household provided feedback from one individual aged 18 or older.
Dr Abu Muhammad Zakir Hussain, a member of the Health Sector Reform Commission, said the commission had requested the Bureau to conduct the survey to gather public opinion on healthcare.
"Many of the suggestions from the survey align with our own recommendations," he told TBS.
High doctor, surgery fees
According to the survey findings, 57.6% and 49.6% of respondents expressed concerns about high doctor and surgery fees in private hospitals.
Moreover, 97.6% of rural respondents believe there should be at least one MBBS doctor at every Union Health Centre, while 92.7% of urban residents want similar facilities at ward health centres.
Dr Zakir Hussain said they recommended that primary healthcare services be free, with all services available to the poorest at no cost. They also proposed a 5% increase in the healthcare budget, which could significantly improve service quality.
"Moreover, we need to introduce a social health insurance system, where employers and employees in the formal sector contribute. This system would enable the poor to receive support without the government having to provide direct cash assistance," he added.
He further said they repurposed to restrict pharmaceutical representatives from visiting doctors during office hours.
The survey also found that 61.7% of respondents had never heard of health insurance, but 71.1% indicated they would be willing to participate in a health insurance scheme with a fixed monthly fee.
Furthermore, 76.4% believe that healthcare professionals, including doctors and medical staff, should refrain from political activities at their workplaces.
Medicines, services
On the issue of prescription practices, 68.3% of people opposed the sale of antibiotics in pharmacies without an MBBS doctor's prescription, while 65.8% rejected the practice of pharmaceutical representatives visiting doctors' offices to promote specific medications.
In response to service delivery concerns, Dr Zakir Hussain mentioned that the commission recommended a minimum of 10 minutes of consultation time per patient, despite the survey's suggestion of 20 minutes.
"Our recommendation is to strengthen primary healthcare services so that people do not crowd district or tertiary hospitals. A referral system will also be implemented to ensure patients are referred from union or sub-district health complexes for further treatment."
Seeking treatment abroad
The survey also sheds light on the increasing trend of Bangladeshis seeking medical treatment abroad, with 2.4% of the population travelling for healthcare. Among those who sought treatment abroad, heart disease was the most common reason (29.4%), followed by cancer (14.8%) and kidney diseases (13.5%).
Professor Dr Syed Md Akram Hossain, a cancer specialist and member of the Health Sector Reform Commission said treatment for these conditions should be available within the country through public, private, or public-private partnerships.
"If private institutions can provide such treatments, they should be VAT and tax-free, allowing them to import equipment at lower costs and offer services at affordable prices. This would reduce the number of patients seeking treatment abroad and improve our healthcare system," said Dr Hossain.
The survey results have been submitted to the Health Sector Reform Commission, which will present its final recommendations to the government by 31 March.
