Mapping Two Decades of Evidence and Actionable Needs for Financial Burden in Health Research in Bangladesh: A Systematic Review

Financial risk protection (FRP), assessed at the population level through catastrophic health expenditure (CHE) and impoverishment indicators under SDG 3.8, reflects the extent to which health systems shield households from financial hardship due to out‐of‐pocket (OOP) payments. FRP must be distinguished from disease‐specific cost‐of‐illness studies, which measure condition‐level OOP expenditures rather than population‐level financial protection. In Bangladesh, persistent gaps in FRP continue to expose households to financial hardship and impoverishment. Despite a growing evidence base, no study has systematically mapped the evolution of health‐related financial burden research in Bangladesh. This review synthesizes two decades of scholarship encompassing population‐level FRP and disease‐specific cost‐of‐illness evidence as analytically distinct categories. Following PRISMA guidelines, we reviewed 93 peer‐reviewed articles published between 2005 and 2025 from Web of Science and Scopus databases. Bibliometric mapping was combined with thematic synthesis to analyze publication trends, citation patterns, collaboration networks, and methods. Population‐level evidence on CHE incidence, determinants, impoverishing effects, and coping mechanisms was synthesized as primary FRP indicators, while disease‐specific OOP studies were examined as contextual evidence on condition‐level cost burdens. Results show a high and rising CHE burden disproportionately affecting rural, low‐income, disease‐affected, and disaster‐prone households. Health system regressivity, expanding private provision, and limited risk pooling exacerbate financial vulnerability. Thematic analysis reveals a transition from descriptive studies to equity‐oriented, solution‐focused research aligned with SDG‐era priorities. This review provides an evidence base for strengthening equitable, resilient health financing reforms in Bangladesh and underscores the need to distinguish population‐level financial protection from disease‐specific cost burdens in future research.