Out of Pocket Expenditure for Sick Newborn Care in Referral Hospitals of Nepal

Avinash K Sunny,Ashish Kc,Abhishek Gurung,Omkar Basnet,Rejina Gurung

doi:10.1007/s10995-020-02881-y

Avinash K Sunny, Ashish Kc + Show 3 more

Open Access

https://doi.org/10.1007/s10995-020-02881-y

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Abstract

BackgroundAlmost all preventable neonatal deaths take place in low- and middle-income countries and affect the poorest who have the least access to high quality health services. Cost of health care is one of the factors preventing access to quality health services and universal health coverage. In Nepal, the majority of expenses related to newborn care are borne by the caregiver, regardless of socioeconomic status. We conducted a study to assess the out of pocket expenditure (OOPE) for sick newborn care in hospitals in Nepal.MethodsThis cross-sectional study of hospital care for newborns was conducted in 11 hospitals in Nepal and explored OOPE incurred by caregivers for sick newborn care. Data were collected from the caregivers of the sick newborn on the topics of cost of travel, accommodation, treatment (drugs, diagnosis) and documented on a sick newborn case record form.ResultsData were collected from 814 caregivers. Cost of caregivers’ stay accounted for more than 40% of the OOPE for sick newborn care, followed by cost of travel, and the baby’s stay and treatment. The overall OOPE ranged from 13.6 to 226.1 US dollars (USD). The median OOPE was highest for preterm complications ($33.2 USD; CI 14.0–226.1), followed by hyperbilirubinemia ($31.9 USD; CI 14.0–60.7), respiratory distress syndrome ($26.9 USD; 15.3–121.5), neonatal sepsis ($ 25.8 USD; CI 13.6–139.8) and hypoxic ischemic encephalopathy ($23.4 USD; CI 13.6–97.7).Discussion for practiceIn Nepal, OOPE for sick newborn care in hospitals varied by neonatal morbidity and duration of stay. The largest proportion of OOPE were for accommodation and travel. Affordable and accessible health care will substantially reduce the OOPE for sick newborn care in hospitals.

Highlights

Each year 19 million neonates have life-threatening conditions including intrapartum related brain injury, pathological jaundice, severe bacterial infections and preterm birth which require specialized care (Bhutani et al 2013; Blencowe et al 2013; Lawn et al 2013; Lee et al 2013; Seale et al 2013)
Mothers were generally young with an average of 23 years and the majority were from Brahmin and Chhetri castes (n = 355, 43.6%)
The OOPE reported ranged from US dollars (USD) 13.6 to 226.1 with a mean of USD 31.3

Summary

Introduction

Each year 19 million neonates have life-threatening conditions including intrapartum related brain injury, pathological jaundice, severe bacterial infections and preterm birth which require specialized care (Bhutani et al 2013; Blencowe et al 2013; Lawn et al 2013; Lee et al 2013; Seale et al 2013). 2.9 million neonates die due to complications from preterm birth (34%), intrapartum-related conditions (25%), and infections (22%) (Lawn et al 2014). Almost all of these deaths take place in LMICs and most of them occur in families who are poor and have least access to services (Lawn et al 2005). To further progress in reducing neonatal mortality so as to reach the target set by WHO Every Newborn Action Plan of 10 or less newborn deaths per 1000 live births by 2035, financial barriers for sick newborns needs to be removed coupled with improvement in quality of care (UNICEF 2014). Affordable and accessible health care will substantially reduce the OOPE for sick newborn care in hospitals

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