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Financing Road Construction and Maintenance after the Fuel Tax Reform
dc.description.abstractThe Government of Bangladesh has made it a priority to expand access by the poor to maternal, neonatal, and child health (MNCH) services. Central to its strategy is the provision of healthcare services at free or nearly free prices through Ministry of Health and Family Welfare (MOHFW) facilities. However, poor families make less use of MOHFW services than the non-poor, and many patients are reported to incur significant costs at MOHFW facilities. The Patient Exit Survey (PES) 2011 carried out exit interviews of over 5,000 inpatients and outpatients at a representative sample of MOHFW facilities in order to find out why patients incur out-of-pocket expenses at MOHFW facilities, to quantify their size, and to assess the impact of demand-side financing (DSF) pilot schemes on patient out-of-pocket costs and utilization of MNCH services. Almost all outpatients and inpatients report out-of-pocket expenses associated with their healthcare visits. These fall into four categories: (i) travel costs to reach the healthcare institution, (ii) official fees charged by MOHFW facilities, (iii) informal or unofficial fees paid to persons inside the facility to obtain services or other benefits, and (iv) the costs of purchasing medicines recommended by the medical staff that which are not available at the health facility. The major out-of-pocket expense reported is purchasing medicines and supplies that are recommended by medical staff but are not available at the facility. About 50% of outpatients and over 90% of inpatients report such costs, which average Tk301 per outpatient and Tk980 per inpatient. Travel costs to the facility average Tk27 for outpatients and Tk131 for inpatients, however, travel costs for expectant mothers are much higher and average Tk220. About 50% of outpatients and 75% of inpatients report having to pay official fees, with inpatient women who had delivered, reporting higher-than-average fees. The incidence of informal payments is much lower than anticipated, with most outpatients reporting no such expenses. There have been large increases since 2006 in facility childbirths at facilities enrolled in the DSF schemes, with the greatest impact seen in those enrolled in the universal DSF schemes. However, findings show that the DSF actual out-of-pocket costs incurred at the time of treatment are no lower at DSF enrolled facilities, and that equity of utilization does not seem to have been improved.
dc.publisherAsian Development Bank
dc.rightsCC BY 3.0 IGO
dc.titleFinancing Road Construction and Maintenance after the Fuel Tax Reform
dc.subject.expertWorld Health Organization
dc.subject.expertUrban Health Services
dc.subject.expertRural Health Services
dc.subject.expertNutrition and Health Care
dc.subject.expertHealth Aspects of Poverty
dc.subject.expertHealth and Hygiene and the Poor
dc.subject.expertEducation, Health and Social Protection
dc.subject.expertAccess to Health Care
dc.subject.expertSocial Aspects Of Poverty
dc.subject.adbDisease Control
dc.subject.adbOccupational Hygiene
dc.subject.adbMedical Services
dc.subject.adbHealth Costs
dc.subject.adbWater Quality
dc.subject.adbRespiratory Diseases
dc.subject.adbHealth Indicators
dc.subject.adbDisadvantaged Groups
dc.subject.adbMedical centers
dc.subject.adbPrenatal Care
dc.subject.adbMedical Services
dc.subject.adbMedical Economics
dc.subject.naturalCost of medical care
dc.subject.naturalHealth status indicators
dc.subject.naturalSanitation services
dc.subject.naturalPrevention of disease
dc.subject.naturalHealth status indicators
dc.subject.naturalCost and standard of living
dc.subject.naturalMedical centers
dc.subject.naturalCost of medical care
dc.subject.naturalHealth services for women
dc.contributor.imprintAsian Development Bank
oar.adminregionSoutheast Asia Region
oar.authorAsian Development Bank

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