Healthcare Expenses Drive Millions into Poverty

A hospital should be a refuge from suffering, not a gateway to debt, destitution and despair. Yet in Bangladesh, the cost of staying alive forces families to exhaust savings, sell land and sacrifice basic necessities. When essential medicines become unaffordable and treatment inaccessible, illness exposes a deeper failure to protect human dignity and the right to health.

A study by the Health Economics Unit of the Ministry of Health and Family Welfare, supported by the World Health Organisation (WHO), found that out-of-pocket healthcare expenditure pushed more than 1.08 crore people below the national poverty line in 2022. Another 41.7 per cent of the population experienced financial hardship due to medical costs.

The burden has grown relentlessly. Average monthly out-of-pocket healthcare spending, adjusted for inflation, rose from Tk 1,241 in 2005 to Tk 3,238 in 2022. The proportion of households reporting such expenditure increased from 52.5 per cent to 92.7 per cent. Financial hardship affected 90.8 per cent of the poorest consumption group, against 13.6 per cent of the wealthiest. Rural households suffered more than urban ones, at 47.9 per cent and 28.2 per cent respectively.

Behind these figures lies a punishing reality. Cancer patients may require repeated chemotherapy, expensive medicines and diagnostic tests, while kidney patients may need dialysis several times a week. Prolonged treatment can drain savings, force land sales and drive families into debt. Missing treatment because of poverty is not a choice but a consequence of a system that leaves patients bearing costs they cannot afford.

The gap between public and private healthcare compounds the crisis. According to the study, private outpatient and inpatient treatment costs 128 per cent and 139 per cent more, respectively, than comparable public care. Yet public hospitals often face medicine shortages, overcrowding and inadequate resources, forcing patients to buy medicines externally, pay for tests elsewhere or seek costly private treatment. Opaque bills, alleged unnecessary tests and weak oversight further undermine trust.

This is not merely a failure of affordability but of making healthcare rights meaningful. Article 15 of the Constitution recognises medical care as a basic necessity, while Article 18 directs the State to improve public health. The International Covenant on Economic, Social and Cultural Rights recognises the right to the highest attainable standard of health. These commitments ring hollow when access to treatment depends on a patient’s ability to pay.

People deserve safe medicines, competent doctors, necessary tests, transparent bills and timely treatment without humiliation, exploitation or financial ruin. They must be able to challenge unjustified charges without fear. Above all, illness must not condemn an entire family to poverty.

Healthcare is a right, not charity. Its true measure lies not in the number of hospitals built, but in whether people can obtain safe, timely and dignified treatment without sacrificing their livelihoods. No family should have to descend into poverty to keep a loved one alive.