Out-of-pocket and catastrophic healthcare expenditure in Bangladesh: a nationwide comparative study of households with and without disabled members

Despite Bangladesh’s heavy reliance on out-of-pocket (OOP) healthcare financing and the absence of disability-specific financial protection provisions, no nationally representative study has compared OOP expenditure and catastrophic health expenditure (CHE) between households with and without disabled members in Bangladesh. The study aims to estimate OOP healthcare expenditure, incidence of CHE, and to identify socioeconomic factors associated with CHE incidence among households with and without disabled members in Bangladesh. This cross-sectional study used secondary data from the Bangladesh Household Income and Expenditure Survey (HIES) 2022. The Washington Group short set of questions was administered to identify self-reported disability. CHE was defined using the capacity-to-pay approach, applying a 40% threshold of non-food expenditure. Survey-weighted multivariate binary logistic regression models were estimated to identify factors associated with CHE incidence. Of the 13,931 surveyed households, 2,732 (19.13%) had at least one disabled member. Among households incurring healthcare costs, those with disabled members had significantly higher mean monthly OOP expenditure (BDT 4,972 vs. BDT 3,288; p < 0.001) and allocated a greater share of non-food expenditure to healthcare (27.76% and 18.99%, respectively). CHE incidence was substantially higher in those households (23.46%; CI: 21.56–25.48), with an overall incidence of 15.53%. Multivariate regression analysis identified chronic illness (AOR: 5.20; CI: 2.99–9.04; p < 0.001), inpatient service use (AOR: 3.27; CI: 2.47–4.33; p < 0.001), and private facility use (AOR: 2.71; CI: 1.72–4.26; p < 0.001) as the strongest predictors of CHE in households with disabled members. Asset quintile was not significantly associated with CHE in those households, although it was significant in other households. No significant difference in coping strategy distribution was identified between groups ( p = 0.687). Descriptively, households with disabled members relied more on regular income and borrowing, and less on savings, though these patterns are exploratory. Households with disabled members face substantially higher OOP expenditure and CHE despite comparable non-food expenditure, indicating a potential gap in Bangladesh’s financial protection policy. Findings suggest that closing this gap may require policy responses including strengthening public provision of specialised disability care, integrated care pathways for disability and chronic disease management, and routine disability-disaggregated data monitoring to track progress.