Evidence on information, access frictions, and experience in public healthcare use in rural Bangladesh: a cluster-randomized field experiment.
Mohammad Asif Hasan Khan
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In 30 seconds
This cluster-randomized field experiment tested whether information, access frictions, or uncertainty about public care helps explain reliance on private and informal providers among rural Bangladeshi households. Across three sequential treatment arms, information increased awareness of public options but had limited effects on use. Encouraging a one-time experience with public care increased public uptake and substitution away from informal providers. Households induced to use public care spent ∼601 Bangladeshi taka (USD 5.46 at 2023 exchange rate; 32% of the control group mean) less on health than nonusers, with most of the reduction attributable to medicines.
Key findings
- Information provision sharply increased awareness of public care options but had limited effects on actual utilization.
- Encouraging a one-time public-care experience significantly increased public uptake and substitution away from informal providers.
- Induced public-care users spent ∼601 Bangladeshi taka (USD 5.46 at 2023 exchange rate; 32% of the control group mean) less than nonusers (95% CI 373-829 taka; P < 0.001).
- Most of the spending reduction was driven by lower medicine expenditure.
Why it matters
The findings distinguish awareness from actual care-seeking: information alone may not overcome uncertainty about public services. A first experience with public care was associated with greater public uptake and lower out-of-pocket spending, suggesting that confidence built through service use may matter when households choose among public, private, and informal providers.
What to keep in mind
The experiment was conducted in rural Bangladesh, so the findings may not generalize to other settings. The reported spending comparison concerns households induced to use public care relative to nonusers.