Health Policy and Planning, Vol 14, 152-163, Copyright © 1999 by Oxford University Press
J Killingsworth, N Hossain, Y Hedrick-Wong, S Thomas, A Rahman and T Begum
The widespread collection of unofficial fees at health facilities is a
common form of rent-seeking behaviour in Bangladesh. Typically, unofficial
fees come in the form of cash payments for the performance of required
services, for direct purchase of drugs and medical-surgical requisites, and
for service access. Using observational and interview methods, this study
explores linkages between official and unofficial fees at three Bangladesh
health facility levels: primary care Thana Health Complexes, secondary or
district hospitals, and medical college hospitals. The study estimates
payment levels for different income classes and different payor types at
these facilities, thereby highlighting potential equity, price and
institutional questions associated with unofficial fees. Not only does the
practice have clear income and equity effects, there also appear to be
direct effects upon patient satisfaction, perception of quality, and the
ability to pay for health services. The article concludes with a discussion
of 'rent capture' processes in Bangladesh facilities and the effect of
unofficial fees in six areas of health sector reform: displaced official
policies, reduced merit goods production, upward income redistribution,
distorted human resource development, growth of facility inefficiency, and
obstruction of market reforms.
ARTICLES
Unofficial fees in Bangladesh: price, equity and institutional issues
Health Economics Unit, Ministry of Health and Family Welfare, Dhaka, Bangladesh; Maxwell Stamp Plc, London, UK; Data International, Dhaka, Bangladesh; Health Economics Unit, University of Cape Town, South Africa
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