Abstract
Background and objectiveInformation on out-of-pocket (OOP) expenditure during childbirth in public and private health facilities in India is needed to make rational decisions for improving affordability to maternal care services. We undertook this study to evaluate the OOP expenditure due to hospitalization from childbirth and its impact on households.MethodsThis is a secondary data analysis of a nationwide household survey by the National Sample Survey Organization in 2014. The survey reported health service utilization and health care related expenditure by income quintiles and type of health facility. The recall period for hospitalization expenditure was 365 days. OOP expenditure amounting to more than 10% of annual consumption expenditure was termed as catastrophic.ResultsMedian expenditure per episode of hospitalisation due to childbirth was US$54. The expenditure incurred was about six times higher among the richest quintile compared to the poorest quintile. Median private sector OOP hospitalization expenditure was nearly nine times higher than in the public sector. Hospitalization in a private sector facility leads to a significantly higher prevalence of catastrophic expenditure than hospitalization in a public sector (60% vs. 7%). Indirect cost (43%) constituted the largest share in the total expenditure in public sector hospitalizations. Urban residence, poor wealth quintile, residing in eastern and southern regions of India and delivery in private hospital were significantly associated with catastrophic expenditure.ConclusionsWe strongly recommend cash transfer schemes with effective pro-poor targeting to reduce the impact of catastrophic expenditure. Strengthening of public health facilities is required along with private sector regulation.
Highlights
Background and objectiveInformation on out-of-pocket (OOP) expenditure during childbirth in public and private health facilities in India is needed to make rational decisions for improving affordability to maternal care services
Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of promoting institutional delivery by providing cash assistance to the poorest and Tripathy et al BMC Res Notes (2017) 10:409 the marginalized
IQR inter quartile range, monthly per capita consumption expenditure (MPCE) monthly per capita expenditure a Expenditure amounting to more than 10% of annual consumption expenditure is defined as catastrophic b Indirect cost includes transport for patient and others, expenses on food, escort, lodging charges and others, etc Median OOP hospitalization expenditure was nearly nine times higher in private sector as compared to public sector
Summary
Information on out-of-pocket (OOP) expenditure during childbirth in public and private health facilities in India is needed to make rational decisions for improving affordability to maternal care services. The maternal mortality ratio in India showed a decline from 301 deaths per 100,000 live births in the period 2001–03 to 178 during 2010–12, but still lagged behind the Millennium Development Goal target of 109 by the year 2015 [2]. To improve the availability and accessibility to quality health care services in public health centres, the Government of India launched the National Rural Health Mission (NRHM) in 2005—the largest flagship programme in the country. In order to improve financial access to institutional deliveries, the Government of India launched Janani Shishu Suraksha Karyakram (JSSK) in 2011 which provides free delivery and medical treatment of sick neonates for up to 30 days of birth in public health facilities. The mission has led to enhanced utilization of public health facilities for childbirths and accelerated reduction in infant and neonatal mortality [6]
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