Abstract
BackgroundThis study aimed to determine the magnitude of and factors associated with out-of-pocket expenditure (OOPE) during the first prenatal clinic visit among pregnant women in Anuradhapura district, Sri Lanka, which provides free maternal healthcare.MethodsThe study design was a cross-sectional study, and the study setting was 22 Medical Officers of Health (MOOH) areas in Anuradhapura District, Sri Lanka. Data of 1389 pregnant women were analyzed using descriptive statistics and non-parametric tests.ResultsThe mean OOPE of the first prenatal clinic visit was USD 8.12, which accounted for 2.9 and 4.5% of the household income and expenditure, respectively. Pregnant women who used only government-free health services (which are free of charge at the point of service delivery) had an OOPE of USD 3.49. A significant correlation was recorded between household expenditure (rs = 0.095, p = 0.002) and the number of pregnancies (rs = − 0.155, p < 0.001) with OOPE. Education level less than primary education is positively contributed to OOPE (p < 0.05), and utilizing government-free maternal health services lead to a decrease in the OOPE for the first prenatal clinic visit (p < 0.05).ConclusionDespite having free maternal services, the OOPE of the first prenatal clinic visit is high in rural Sri Lanka. One-fifth of pregnant women utilize private health services, and pregnant women who used only government-free maternal health services also spend a direct medical cost for medicines/micronutrient supplements.
Highlights
This study aimed to determine the magnitude of and factors associated with out-of-pocket expenditure (OOPE) during the first prenatal clinic visit among pregnant women in Anuradhapura district, Sri Lanka, which provides free maternal healthcare
We explored the following two questions that remain unanswered in the rural Sri Lankan context: What are the magnitudes of OOPE of the first prenatal clinic visit of rural Sri Lanka? What are the associated factors of OOPE in the first prenatal clinic visit?
The OOPE occurred for pregnant women who used private medical care and government-free health facilities using descriptive statistical measures
Summary
This study aimed to determine the magnitude of and factors associated with out-of-pocket expenditure (OOPE) during the first prenatal clinic visit among pregnant women in Anuradhapura district, Sri Lanka, which provides free maternal healthcare. The concept of out-of-pocket expenditure (OOPE) on health care refers to the payments made by individuals and families for medical services [1] which is widely. The failure of the aims in the health care system is caused by high OOPE, especially in the countries which have imposed free health facilities at the time of service delivery [13, 15, 16, 23, 25]. High OOPE is a barrierto achieve global health-related goals Universal Health Coverage [4] and the Sustainable Development Goals (SDGs)-goal 3, and Good Health and Wellbeing [26, 27]
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