Evidence on information, access frictions, and experience in public healthcare use in rural Bangladesh: a cluster-randomized field experiment.

In rural Bangladesh, many households continue to rely on private and informal providers even when public healthcare options are available at low or zero monetary cost. This paper studies whether the barrier is mainly misinformation, access frictions, or trust and uncertainty about public care. A cluster-randomized field experiment was conducted with 2320 households across 580 neighborhoods and three sequential treatment arms. Information provision sharply increases awareness of public care options but has limited effects on actual utilization. In contrast, encouraging a one-time experience with public care produces significant increases in public uptake, substitution away from informal providers, and meaningful reductions in out-of-pocket spending, especially on medicines. Households induced to use public care reduced total health spending by ∼601 Bangladeshi taka (USD 5.46 at 2023 exchange rate; 32% of the control group mean) relative to nonusers (95% CI 373-829 taka; P < 0.001), with most of the reduction driven by lower medicine expenditure. The findings suggest that improving beliefs alone is insufficient and that lowering uncertainty through a first successful experience is a key lever for shifting healthcare demand toward public options.