Crowding-out and crowding-in effects of out-of-pocket expenditures for non-communicable diseases care on household consumption patterns in Bangladesh: a cross-sectional analysis of the 2022 household income and expenditure survey.

Abstract

This study aims to analyse the crowding-out and crowding-in effects of non-communicable diseases (NCDs) related out-of-pocket (OOP) health expenditures on household consumption in Bangladesh.

Objective: DESIGN: This study used data from the nationally representative Bangladesh household income and expenditure survey (HIES) 2022.

Setting: Eight divisions of Bangladesh.

Participants: 14 395 households.

Primary and secondary outcome measures: We examined how household consumption patterns across 20 expenditure categories were impacted by OOP health spending for NCD management, with a focus on income-level disparities.

Results: In Bangladesh, OOP health expenditures for NCDs crowded out household expenditures on essential items like food and rent. Across all households, OOP health expenditures for NCDs by 10 US$ crowded out -3.8 US$ of expenditure on food (95% CI -5.1 to -2.5), and more specifically on protein-rich foods (-2.0 US$, 95% CI -2.8 to -1.2), spices (-0.2 US$, 95% CI -0.3 to -0.1), and restaurant and café meals (-0.9 US$, 95% CI -1.4 to -0.5). Crowding-out was also seen for tobacco, rent, durable goods and miscellaneous. In lower-income households, expenditures on food (-4.1 US$, 95% CI -7.2 to -1.1), restaurant and café meals (-2.0 US$, 95% CI -3.1 to -0.8), spices (-0.4 US$, 95% CI -0.7 to -0.09), and rent (-3.1 US$, 95% CI -4.5 to -1.6) were significantly crowded out.

Conclusion: This research demonstrates that NCD-related spending in Bangladesh reduces budgets for both food and non-food expenditures, with a stronger crowding-out effect on food items and rent, particularly in lower-income households. Effective financial and social protection mechanisms against NCDs are warranted to safeguard the consumption of the NCD-affected households in Bangladesh.