Amid high inflation, living with illness means carrying a double burden

On some days, Dolon simply stops taking her medicine. Not because her condition has improved or doctors advised her to. She stops because she is exhausted mentally, financially and emotionally.

Almost all her salary now disappears into medication and treatment. Every few months, prices rise again — quietly but relentlessly — outpacing her income and shrinking her choices.

"This is one of the reasons I don't even think about getting married," she said. "When I think about children, I feel scared. I can barely manage my own life."

However, for Saiful Islam, a thyroid cancer patient, daily medication is non-negotiable. Missing a single day once landed him in emergency care, with doctors fearing a relapse. But inflation has meant that life is shrinking inch by inch.

"I must undergo Tg, anti-Tg, serum calcium, scans, FT3 and FT4 tests every three months. Once the reports stabilised after a year, the tests became mandatory every six months. I must take three Thyronorm 50 tablets daily. Missing even one day causes complications. When I first started the medication, one strip cost Tk120. Then it became Tk180, and now it is Tk240. I have no choice but to take it," Saiful said. 

"Earlier, I used to buy shirts worth Tk1,000; now I buy ones priced at Tk600. Where I once ate two kilograms of fish per week, I now eat one. This is how I am adjusting. There is no alternative," he added.

Since inflation accelerated after 2022, illness has become not just a health crisis in Bangladesh but a financial one. Families are cutting back on food, clothing, travel — even dignity — selling homes, skipping doses, and delaying treatment just to survive rising medical costs amid a broader cost-of-living squeeze.

Skipping doses, selling homes, taking loans

Bangladesh today bears one of the heaviest private healthcare burdens in the world. According to official data from the National Health Accounts, 68.5% of medical expenses were paid out of pocket in 2020, rising to around 73% in 2021. Only war-torn Afghanistan fares worse. The World Health Organization recommends a maximum of 20%.

Behind these numbers are people like Dolon and Saiful, recalibrating their lives around pills, test reports, and medical bills.

In Rajshahi, Nadim Abdullah runs a small shop that supports his father, younger sister, wife, and himself. When someone in the family falls sick, the business grinds to a halt.

"Sometimes we are supposed to take seven days' medicine, but we stretch it over three days," he said. "If I take medicine properly, the shop's cash will be gone."

Loans followed. NGO installments piled up. Eventually, Nadim sold his house.

"My wife has been suffering from gynaecological problems for four years," Nadim explained. "I can't afford proper treatment. I bring home homeopathic medicine just to give her some comfort. It doesn't work. This July, I sold my house. Over more than a decade, my inability to sustain and manage my business led me to accumulate debts of Tk5–7 lakh. I sold my house to repay them."

According to a 2022 survey by the Bangladesh Institute of Development Studies (BIDS), approximately 18% of the households face catastrophic health expenditures and more than 6.13 million people were pushed below the poverty line due to healthcare costs. Households cope by borrowing, selling assets, or simply avoiding treatment altogether. 

My wife has been suffering from gynaecological complications for four years. I can't afford proper treatment. I bring home homeopathic medicine just to give her some comfort. It doesn't work. This July, I sold my house.

Nadim Abdullah, shopowner, Rajshahi

Rumana Huque, professor of Economics at the University of Dhaka and a public health specialist, believes that the crisis cannot be separated from the post-pandemic economy.

"Since Covid-19, people have been under immense pressure," she said. "Add to this the Ukraine–Russia war, the overall economic slowdown, and Bangladesh's political situation.

"What we see in labour force surveys is rising unemployment, especially among women. In this context, the macroeconomic situation is directly affecting people's ability to pay for healthcare from their own income," Rumana added.

Women's unemployment has risen the fastest, even as healthcare costs climb. For many families, women quietly absorb the shock — cutting their own needs first.

Medicines: The biggest drain

The largest share of out-of-pocket spending in Bangladesh goes to medicines. According to BIDS, 54.4% of the cost was spent on purchasing medicines, while the diagnostic cost is 27.52%, 10.31% for consultation and 7.77% for transport cost.

Rumana Huque said Bangladesh's medicine prices are unusually high compared to neighbouring countries.

"If we compare with India, Nepal or Pakistan, medicine prices in Bangladesh are relatively higher. This is often disputed by pharmacists, but comparative data shows clearly that prices here are significantly higher."

The absence of a structured referral system worsens the problem. Patients can buy many drugs over the counter without prescriptions. Self-medication rises. Costs spiral.

"People end up buying medicines on their own," Rumana explained. "That increases out-of-pocket expenditure even further."

In theory, essential medicines are free at public facilities. In reality, supplies dry up fast.

"In many upazila health complexes, medicines run out within 15 to 20 days. After that, patients must buy from their own pocket."

Shoayeb Mahmud from Manikganj knows this well. His mother's diabetes medication costs Tk3,600–4,000 a month. His father's medicines cost another Tk1,600. Their child's skin infection has already drained Tk20,000.

"We borrow from relatives for treatment," he said. "Still, we can't recover."

Doctors often prescribe medicines outside the Essential Drug List, even at public hospitals. Those drugs must be purchased privately, at market prices.

"This creates additional pressure," Rumana Huque mentioned. "Even when people go to government facilities, they still end up paying."

Urban patients face a different trap. Public hospitals are overcrowded and under-resourced, forcing people into private clinics.

"There is no prepayment mechanism, no insurance," Dr Huque said. "In urban areas, people depend heavily on private providers. That pushes costs much higher."

Even within cities, prices vary wildly between clinics. Medicines are often sold under brand names rather than generics, creating confusion and inequality.

"There is disparity between urban and rural areas," she said. "But also disparity within cities themselves."

A system stretched thin

According to the World Bank, financial hardship drops sharply when out-of-pocket spending falls below 20%. Bangladesh is nowhere near that threshold. The root problem lies in chronic underinvestment.

Bangladesh allocates around 1% of GDP to health, far below the WHO-recommended 5%. While health budgets have grown nominally, much of the money goes to salaries and routine expenses. A significant portion remains unspent due to weak implementation.

The result is a system where people with means seek treatment abroad — in India, Thailand, or Malaysia — draining foreign currency, while those without means delay care or fall into poverty.

Professor Rumana argued that the pharmaceutical industry and government both have roles to play.

"The pharmaceutical industry has an important role to play. If companies were willing to reduce their profit margins, prices could come down. Many raw materials and components for medicines are imported, and reducing import taxes on these inputs could also help lower costs. At present, the cost of doing business in Bangladesh — across industries, including pharmaceuticals — is very high," she said.

"If the government were to provide targeted incentives to pharmaceutical manufacturers — such as tax relief, support through export processing zones, or other facilities — particularly for life-saving medicines, prices could be brought down to a more affordable level. This would significantly reduce the financial burden on the public." 

Until then, households will continue to absorb the shock.