Unmet healthcare needs, out-of-pocket payments and catastrophic health expenditures among hypertensive adults in Bangladesh

Abstract Background This study aims to examine unmet healthcare needs and the burden of out-of-pocket (OOP) payments in Bangladesh among hypertensive adults using the most recent survey data. Methods A total of 5086 hypertensive patients aged 18 to 80 were recruited from 75 pharmacies in Bangladesh in 2023, 35 being located in urban areas and 40 in rural areas. Unmet healthcare needs was the primary outcome variable, while the incidence of catastrophic health expenditures (CHE) was the secondary outcome variable. A multilevel logistic regression model was performed to identify factors associated with unmet healthcare needs and CHE. A multilevel Tobit regression model was used to identify the determinants of OOP health expenditures. Results The study indicated that the prevalence of unmet healthcare needs among hypertensive adults was around 26% and incidence of CHE was 46% at 10% threshold of total consumption in Bangladesh. The most common reason for unmet healthcare needs was affordability, long waiting times, lack of availability, and transportation issues etc. Unmet healthcare needs were more prevalent among men, individuals with no education, divorced/separated, non-Muslims and poor population. Regression models suggested that older people, men, those with higher education, Muslim, married people, larger household, overweight and obese people, and rural residents were more likely to burden of OOP expenses. Conclusions High unmet needs and CHE prevalence in Bangladesh reveal inadequate health risk protection. Prioritizing affordability, addressing disparities, and strengthening financial risk protection can improve access and outcomes for hypertensive adults.