ArticleBMJ open2025
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.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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
designThis study used data from the nationally representative Bangladesh household income and expenditure survey (HIES) 2022.
settingEight divisions of Bangladesh.
participants14 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.
resultsIn 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.
conclusionThis 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.
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