Dealing with Healthcare Costs: How Rising Prices Affect Medical Accessibility for Middle- and Lower-Class Households in South-Western Parts of Bangladesh

Authors

  • Taufiq-E-Ahmed Shovo Sociology Discipline, Social Science School, Khulna University, Khulna 9208, Bangladesh

DOI:

https://doi.org/10.53808/KUS.2025.22.01.1375-ss

Keywords:

Healthcare, Price-hike, Financial, Affordability, Policy

Abstract

Affordability of healthcare remains a prime concern in developing countries, disproportionately impacting lower- and middle-income households. In southwestern Bangladesh, high medical costs in the face of inflationary pressures of the economy keep small family units on the margins of forgoing or delaying needed medical care. This qualitative investigation centers on how such low-income families align their health requirements with their financial limitations. Using a two-stage sampling procedure emphasizing initially purposive sampling method followed by respondent-assisted and availability-based methods, 24 participants from the Khulna district were selected for in-depth interviews. These participants were selected from a diverse range of participants living in urban and rural areas. Data were analyzed thematically through NVivo 15 software. The findings point to the observation that financial hardship has pronounced health inequities, nudging many vulnerable families toward self-medication, traditional healing, or simply postponing treatment in the face of further indisposition. The exact methods included buying medicines directly from the pharmacy without prescriptions, avoiding diagnostic tests, and mistrust in public hospitals. The study calls for an intervention from the policymakers for subsidized healthcare provision, an improved health infrastructure in rural locations, and community programs to fill the gap in accessibility and affordability. The study emphasizes the urgent need for policy interventions such as the subsidizing of health services, improving rural health infrastructure, community-based programs, etc. The investigation contributes to other policy discussions on equitable healthcare by addressing affordability and accessibility gaps and offers pragmatic solutions for alleviating healthcare exclusion in low-resource settings.

Downloads

Download data is not yet available.

References

Adams, A. M., Ahmed, T., El Arifeen, S., Evans, T. G., Huda, T., & Reichenbach, L. (2013). Innovation for universal health coverage in Bangladesh: a call to action. The Lancet, 382(9910), 2104-2111.

Agarwal, R., Mazurenko, O., & Menachemi, N. (2017). High-Deductible Health Plans Reduce Health Care Cost And Utilization, Including Use Of Needed Preventive Services. Health Affairs, 36(10), 1762-1768.

Ahmed, S., Ahmed, M. W., Hasan, M. Z., Mehdi, G. G., Islam, Z., Rehnberg, C., . . . Khan, J. A. M. (2022). Assessing the incidence of catastrophic health expenditure and impoverishment from out-of-pocket payments and their determinants in Bangladesh: evidence from the nationwide Household Income and Expenditure Survey 2016. International Health, 14(1), 84-96.

Akter, M., & Kabir, H. (2023). Health inequalities in rural and urban Bangladesh: the implications of digital health. Mayo Clinic Proceedings: Digital Health, 1(2), 201-202.

Al-Worafi, Y. M. (2023). Medicine Availability and Affordability in Developing Countries. In Y. M. Al-Worafi (Ed.), Handbook of Medical and Health Sciences in Developing Countries : Education, Practice, and Research (pp. 1-29). Cham: Springer International Publishing.

Alam, A. T. M. S., Alam, S., Mobasshira, K., Anik, S. M. N., Hasan, M. N., Chowdhury, M. A. B., & Uddin, M. J. (2025). Exploring urban-rural inequalities of maternal healthcare utilization in Bangladesh. Heliyon, 11(2).

Alam, K., & Mahal, A. (2014). Economic impacts of health shocks on households in low and middle income countries: a review of the literature. Globalization and Health, 10(1), 21.

Aminuddin, F., Raman, S., Bahari, M. S., Zaimi, N. A., Mohd Nor Sham Kunusagaran, M. S. J., Zainuddin, N. A., . . . Mohd Hassan, N. Z. A. (2024). Cancer impact on lower-income patients in Malaysian public healthcare: An exploration of out-of-pocket expenses, productivity loss, and financial coping strategies. PLoS One, 19(10), e0311815.

Bilinski, A., Neumann, P., Cohen, J., Thorat, T., McDaniel, K., & Salomon, J. A. (2017). When cost-effective interventions are unaffordable: Integrating cost-effectiveness and budget impact in priority setting for global health programs. PLoS Medicine, 14(10), e1002397.

Biswas, T., Islam, M. S., Linton, N., & Rawal, L. B. (2016). Socio-Economic Inequality of Chronic Non-Communicable Diseases in Bangladesh. PLoS One, 11(11), e0167140.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

Bryman, A. (2012). Social Research Methods: Oxford University Press.

Chernew, M. E., Cutler, D. M., & Shah, S. A. (2021). Reducing Health Care Spending: What Tools Can States Leverage? Retrieved from https://www.commonwealthfund.org/publications/fund-reports/2021/aug/reducing-health-care-spending-what-tools-can-states-leverage?utm_source=

Crouch, M., & McKenzie, H. (2006). The logic of small samples in interview-based qualitative research. Social Science Information, 45(4), 483-499.

Daniel, J. (2011). Sampling Essentials: Practical Guidelines for Making Sampling Choices: SAGE Publications.

de Siqueira Filha, N. T., Li, J., Phillips-Howard, P. A., Quayyum, Z., Kibuchi, E., Mithu, M. I. H., . . . Elsey, H. (2022). The economics of healthcare access: a scoping review on the economic impact of healthcare access for vulnerable urban populations in low- and middle-income countries. International Journal for Equity in Health, 21(1), 191.

Dowhaniuk, N. (2021). Exploring country-wide equitable government health care facility access in Uganda. International Journal for Equity in Health, 20(1), 38.

Dunn, A., Grosse, S. D., & Zuvekas, S. H. (2018). Adjusting Health Expenditures for Inflation: A Review of Measures for Health Services Research in the United States. Health Services Research, 53(1), 175-196.

Ela, M. Z., Shohel, T. A., Shovo, T.-E. A., Khan, L., Jahan, N., Hossain, M. T., & Islam, M. N. (2021). Prolonged lockdown and academic uncertainties in Bangladesh: A qualitative investigation during the COVID-19 pandemic. Heliyon, 7(2), e06263.

Flores, G., Krishnakumar, J., O’Donnell, O., & van Doorslaer, E. (2008). Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty. Health economics, 17(12), 1393-1412.

Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA. Lancet, 395(10223), 524-533.

Guest, G., Bunce, A., & Johnson, L. (2006). How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability. Field Methods, 18(1), 59-82.

Hassan, S. A., Jui, M. A., Al-Mahde, A. E., Islam, T., Juie, I. J., Habiba, U., . . . Rahman, M. A. (2025). Livelihood vulnerability and public health outcomes in south-west coastal regions in Bangladesh. Sustainable Earth Reviews, 8(1), 4.

Joarder, T., Chaudhury, T. Z., & Mannan, I. (2019). Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions. Advances in Public Health, 2019(1), 4954095.

Kabir, A., & Maitrot, M. R. L. (2018). Exploring the effects of health shocks on anti-poverty interventions: Experience of poor beneficiary households in Bangladesh. Cogent Medicine, 5(1), 1468233.

Kelly, M. P., & Barker, M. (2016). Why is changing health-related behaviour so difficult? Public Health, 136, 109-116.

Khatun, M. M., Rahman, M., Islam, M. J., Haque, S. E., Adam, I. F., Chau Duc, N. H., . . . Islam, M. R. (2023). Socio-economic inequalities in undiagnosed, untreated, and uncontrolled diabetes mellitus in Bangladesh: is there a gender difference? Public Health, 218, 1-11.

Kielb, E. S., Rhyan, C. N., & Lee, J. A. (2017). Comparing Health Care Financial Burden With an Alternative Measure of Unaffordability. INQUIRY, 54, 0046958017732960.

Lagarde, M., & Palmer, N. (2011). The impact of user fees on access to health services in low- and middle-income countries. Cochrane Database Syst Rev, 2011(4), Cd009094.

Lang, W., Radke, J. D., Chen, T., & Chan, E. H. W. (2016). Will affordability policy transcend climate change? A new lens to re-examine equitable access to healthcare in the San Francisco Bay Area. Cities, 58, 124-136.

Lune, H., & Berg, B. L. (2017). Qualitative Research Methods for the Social Sciences, Global Edition: Pearson Education Limited.

Mahumud, R. A., Sarker, A. R., Sultana, M., Islam, Z., Khan, J., & Morton, A. (2017). Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh. J Prev Med Public Health, 50(2), 91-99.

Marvasti, A. (2004). Qualitative Research in Sociology: SAGE Publications.

Maxwell, J. A. (2012). The Importance of Qualitative Research for Causal Explanation in Education. Qualitative Inquiry, 18(8), 655-661.

McGinnis, J. M., Stuckhardt, L., Saunders, R., & Smith, M. (2013). Best care at lower cost: the path to continuously learning health care in America.

Mills, A. (2024). Health Care Systems in Low- and Middle-Income Countries. New England Journal of Medicine, 370(6), 552-557.

Moye-Holz, D., van Dijk, J. P., Reijneveld, S. A., & Hogerzeil, H. V. (2017). Policy approaches to improve availability and affordability of medicines in Mexico – an example of a middle income country. Globalization and Health, 13(1), 53.

Musich, S., Wang, S., Hawkins, K., & Klemes, A. (2016). The Impact of Personalized Preventive Care on Health Care Quality, Utilization, and Expenditures. Population Health Management, 19(6), 389-397.

Nasrin, N., Shohel, T. A., Shovo, T. E., Farjana, F., Nizam, H., Heme, M. A., . . . Hossain, M. T. (2023). A qualitative investigation of stressful life events and mental health disorders: The views of patients and caregivers in Bangladesh. PLoS One, 18(2), e0281649.

National Health Council. (2021). Policy Recommendations for Reducing Health Care Costs. Retrieved from https://nationalhealthcouncil.org/additional-resources/policy-recommendations-for-reducing-health-care-costs/?utm_source=

Qin, V. M., Hone, T., Millett, C., Moreno-Serra, R., McPake, B., Atun, R., & Lee, J. T. (2018). The impact of user charges on health outcomes in low-income and middle-income countries: a systematic review. BMJ global health, 3(Suppl 3), e001087.

Rahman, M. (2024). Healthcare accessibility in rural BD. The Financial Express. Retrieved from https://thefinancialexpress.com.bd/views/healthcare-accessibility-in-rural-bd

Rahman, Q. M., Sikder, M. T., Talha, M., Banik, R., & Pranta, M. U. R. (2022). Perception regarding health and barriers to seeking healthcare services among rural rickshaw pullers in Bangladesh: A qualitative exploration. Heliyon, 8(10), e11152.

Richard, P., Walker, R., & Alexandre, P. (2018). The burden of out of pocket costs and medical debt faced by households with chronic health conditions in the United States. PLoS One, 13(6), e0199598.

Rodrigues da Silva, A. C., Sousa da Silva, K. G., Torres Costa, T., de Oliveira Dutra, M., Santos de Oliveira, A. B., de Sousa Silva, R. M., . . . Rocha Araújo, W. M. (2024). The Importance Of Preventive Medicine In Reducing Chronic Diseases. Environmental & Social Management Journal/Revista de Gestão Social e Ambiental, 18(2).

Saha, A., Marma, K. K. S., Rashid, A., Tarannum, N., Das, S., Chowdhury, T., . . . Mistry, S. K. (2022). Risk factors associated with self-medication among the indigenous communities of Chittagong Hill Tracts, Bangladesh. PLoS One, 17(6), e0269622.

Sarker, A. R., Ali, S. M. Z., Ahmed, M., Chowdhury, S. M. Z. I., & Ali, N. (2022). Out-of-pocket payment for healthcare among urban citizens in Dhaka, Bangladesh. PLoS One, 17(1), e0262900.

Shohel, T. A., Nasrin, N., Farjana, F., Shovo, T. E., Asha, A. R., Heme, M. A., . . . Hossain, M. T. (2022). 'He was a brilliant student but became mad like his grandfather': an exploratory investigation on the social perception and stigma against individuals living with mental health problems in Bangladesh. BMC Psychiatry, 22(1), 702.

Sobotko, J. (2024). Making health care more affordable. Retrieved from https://hsph.harvard.edu/news/making-health-care-more-affordable/?utm_source=

Wang, F. (2018). The roles of preventive and curative health care in economic development. PLoS One, 13(11), e0206808.

World Health Organization. (2023). Methodology for the update of the global health expenditure database 2020-2022: World Health Organization.

Yenet, A., Nibret, G., & Tegegne, B. A. (2023). Challenges to the Availability and Affordability of Essential Medicines in African Countries: A Scoping Review. ClinicoEconomics and Outcomes Research, 15(null), 443-458.

Zapata, K. (2025). The Rising Cost of Mental Health Care Is Putting a Strain On Families. Retrieved from https://www.parents.com/the-doctor-is-out-how-financial-barriers-prevent-many-families-from-accessing-mental-health-care-8762774?utm_source=

Downloads

Published

25-06-2025

How to Cite

[1]
T.-E.-A. Shovo, “Dealing with Healthcare Costs: How Rising Prices Affect Medical Accessibility for Middle- and Lower-Class Households in South-Western Parts of Bangladesh”, Khulna Univ. Stud., pp. 170–181, Jun. 2025.

Issue

Section

Social Sciences

Similar Articles

1 2 3 4 5 6 7 8 9 > >> 

You may also start an advanced similarity search for this article.