Each year, approximately 6.1 million people in Bangladesh fall below the poverty line due to the unbearable burden of medical expenses. Despite billions of taka spent on large-scale healthcare projects, financial assistance from international development agencies, and multiple reform commitments, Bangladesh’s healthcare system remains plagued by mismanagement, inequity, and inefficiency.
From rural upazilas to bustling district towns, citizens are routinely forced to travel to Dhaka to seek treatment for serious illnesses, only to be met with long queues, overwhelmed public hospitals, and skyrocketing bills at private clinics. A comprehensive health system outside the capital has yet to emerge, leaving millions vulnerable to both health shocks and economic ruin.
The Hidden Cost of Illness: Poverty: According to data from the Health Economics Unit (HEU) under the Ministry of Health and Family Welfare, the economic cost of healthcare in Bangladesh is devastating. Drawing from the 2022 Household Income and Expenditure Survey conducted by the Bangladesh Institute of Development Studies (BIDS), HEU reports that 3.7% of the population has fallen below the poverty line solely due to health-related expenditures. Of all individuals classified as poor in the country, 20% were driven into poverty because of out-of-pocket medical costs.
“Healthcare costs in Bangladesh are acting like a poverty trap,” said a senior official at HEU, requesting anonymity. “Once a family member falls seriously ill, their financial downfall begins. In many cases, they never recover economically.”
Healthcare Infrastructure: Numbers That Don’t Add Up: Bangladesh has a total of approximately 750 public hospitals, which include medical college hospitals, specialized institutes, and district and upazila-level hospitals. Alongside these, there are around 5,000 registered private hospitals and clinics, boasting more than 95,000 beds.
Combined with public institutions, the country has roughly 167,000 hospital beds.
Yet the availability of facilities tells only part of the story. Despite these numbers, access to quality healthcare is dismal in most parts of the country. Patients from northern, southern, and hilly districts often have no choice but to travel to Dhaka for advanced treatment, especially for heart attacks, strokes, cancer, kidney failure, and liver diseases.
“This centralization of healthcare services in Dhaka shows how little the healthcare system has evolved in terms of equity and decentralization,” said Dr. Nazmul Ahsan, a public health expert.
Out-of-Pocket Expenses: The Crushing Burden: The financial structure of healthcare in Bangladesh is overwhelmingly skewed toward out-of-pocket payments. A staggering 68.5% of all health expenditure is borne directly by patients, according to research by the HEU. Of this, 64% goes toward purchasing medicines.
For families without health insurance or significant savings, a diagnosis of a serious illness can spell catastrophe. Cancer patients spend on average Tk 19,000 per month for treatment. Those with heart diseases incur monthly costs exceeding Tk 8,000. Even patients with chronic but less severe illnesses spend about Tk 3,500 each month.
“More than half of the total health costs go to medicines,” noted a study by BIDS. “Then come diagnostic services and doctors’ fees. Patients are often prescribed expensive brand-name drugs, sometimes unnecessarily, and face diagnostic charges that vary widely from one private facility to another.” Patients Caught Between Neglect and Exploitation: While public hospitals are underfunded and overburdened, private hospitals have become breeding grounds for unchecked profiteering. Test fees are often arbitrarily set. In the absence of a government-mandated price structure based on hospital categories, private hospitals charge what they please for surgeries, bed rents, and other services.
“Health fraud is rampant,” said Mohammad Shahidul Islam, a journalist covering health issues. “From district towns to urban areas, patients are fleeced by clinics with no accountability. Even if someone becomes destitute, no one steps in to regulate or protect them.”
This absence of regulation has also led to a loss of trust in the healthcare system. Patients often believe doctors have collusions with pharmaceutical companies or diagnostic centers. Allegations of unnecessary surgeries, inflated bills, and negligence are commonplace.
Crisis of Confidence and Access: “The country’s health system is facing a crisis of trust,” said Professor Dr. Syed Abdul Hamid, Director of the Institute of Health Economics at Dhaka University. “High costs, long waits, and frequent mismanagement deter people from seeking care. Those who can, rush to Dhaka; those who can’t, suffer silently or go broke.”
The situation is even more grim for rural populations. Government health centers often lack doctors, modern diagnostic machines, or even essential medicines. Patients seeking emergency care must travel several hours, often at risk to their health. Even after reaching a district or divisional hospital, they are frequently referred to specialized centers in Dhaka due to a lack of proper treatment facilities.
Trust Deficit in Private Sector and Need for Reform: The private sector’s dominance has not been matched by regulation. Patients often cannot differentiate between clinics offering quality services and those simply set up for profit.
“Private hospitals must be categorized and regulated,” emphasized Dr. Hamid. “We need price caps for operations, room rents, and diagnostic tests, and these prices must correspond to the category of the hospital. Quality assurance must also be ensured.”
He also recommended audits of prescriptions to identify irrational drug use and over-testing. “Prescription auditing can curb medical malpractice and promote rational care. Also, public diagnostic services must be strengthened to reduce dependency on the private sector.”
Insurance: The Missing Piece: Bangladesh’s healthcare system remains largely uninsured. According to HEU studies, less than 1% of the population has access to any form of health insurance. As a result, households must bear the full brunt of medical costs when illness strikes.
“Without a national health insurance system, medical expenses will continue to drive people into poverty,” said a senior health official. “We are not just facing a health crisis; it’s a major socio-economic issue.”
Countries with functional health insurance systems tend to have better outcomes, as risks and costs are pooled. But in Bangladesh, with insurance still absent, illness becomes both a medical and financial death sentence for many families. Donor-Funded Projects: Where’s the Impact: Bangladesh has received substantial foreign aid for health sector reforms. Over the past decade, the government has implemented large-scale projects with support from organizations such as the World Bank, JICA, USAID, and others. These projects often aim to improve maternal health, upgrade rural hospitals, digitize health services, and train medical personnel.
Yet despite such efforts, healthcare delivery remains disjointed and inefficient. Corruption, weak monitoring, lack of trained manpower, and infrastructure bottlenecks continue to stall progress. “Donor funds have often ended up in training programs that produce no practical improvements, or in procurement deals that are never audited,” said a source close to a donor-funded healthcare initiative. “Unless there’s systemic change, project-based interventions won’t solve the deeper problems.”
Recommendations from Experts: Health economists, public health professionals, and policy analysts are unanimous on a few urgent priorities:
Implement National Health Insurance: Pilot projects have been tested in select upazilas, but a national rollout is essential. Pooling risks can reduce the financial burden on individuals.
Strengthen Public Hospitals: Investment in district-level hospitals with specialized care units is vital to reduce the Dhaka-centric nature of healthcare.
Price Regulation for Private Hospitals: Categorize hospitals and fix the range of charges for treatment, surgery, and diagnostics based on infrastructure and service quality.
Prescription Audits and Rational Medicine Use: Establish regulatory mechanisms to track prescriptions, curtail unnecessary drug use, and combat pharmaceutical malpractice.
Expand Public Diagnostic Services: Equip all district and upazila hospitals with standard diagnostic machines and ensure skilled manpower to operate them.
Decentralize Healthcare Administration: Allow local health authorities more control and accountability in running hospitals and implementing reforms.
Develop a Robust Referral System: Patients should not have to navigate the maze of hospitals on their own. A streamlined referral protocol can guide them to appropriate care efficiently. The alarming figure of 6.1 million people falling below the poverty line due to medical costs is a wake-up call for Bangladesh. Behind each number lies a story of desperation - a father selling land to buy medicines, a mother skipping meals to pay for her child’s surgery, a young woman abandoning treatment for fear of debt.
Health is a fundamental right, not a luxury. For Bangladesh to achieve its development goals and uplift its citizens, it must first ensure that its people do not go bankrupt to stay alive. Reforming the health sector is no longer a policy option - it is an urgent moral, social, and economic necessity.
