Abstract
Institutional delivery in Nepal is increasing in the past decades and has been the priority program of the government of Nepal. However, due to the hidden costs related to institutional deliveries, the financial burden remains unacceptably high for poor households. The study aimed to find out the major out of pocket expenditure on health service delivery at a tertiary care hospital in Kathmandu, Nepal. A descriptive cross-sectional study was carried out at a tertiary care hospital from December 2018 to May 2019. Ethical approval was taken from Nepal Health Research Council (ref. no. 2087) and permission was taken from the hospital. Informed consent was taken from the participants. Convenient sampling was done. A semi-structured questionnaire was used as a tool for the interview. Data was entered into Epidata and analyzed using the Statistical Package of the Social Sciences version 23. Descriptive analysis was done using mean, median, standard deviation, inter-quartile range, frequency, and percentage. The median out of pocket expenditure of the participants to maternal delivery was NRs. 11720 (7610-20263). The median expenditure was found highest for food and drinking NRs. 2500 (1500-5550) and transportation NRs. 2150 (1400-4543) respectively. Indirect expenditures were found to be higher than direct medical expenditures. Accessibility of the birthing centers and health insurance may reduce the costs related to maternal deliveries.
Highlights
IntroductionThe reduction in maternal and child mortality has accelerated in a few decades but the scenario of developing countries is different.[1,2] The reasons behind this is the lack of access to health services, especially among the poor, where healthcare access often imposes a substantial economic burden.[3] The constitution of Nepal addresses health as a fundamental right and provides a platform for free basic health care services free of cost.[4]
Institutional delivery in Nepal is increasing in the past decades and has been the priority program of the government of Nepal
Ethical approval was taken from Nepal Health Research Council (Reference no: 2087) and permission was taken from Paropkar Maternity and Women’s hospital
Summary
The reduction in maternal and child mortality has accelerated in a few decades but the scenario of developing countries is different.[1,2] The reasons behind this is the lack of access to health services, especially among the poor, where healthcare access often imposes a substantial economic burden.[3] The constitution of Nepal addresses health as a fundamental right and provides a platform for free basic health care services free of cost.[4]. To expand access to safe deliveries, Nepal has initiated the Safe Delivery Incentive Programme (SDIP) in 2006 focusing on reducing the high costs related to accessing healthcare at childbirth.[5] Despite free delivery and incentive, hidden costs continue to exist.[6] Different studies conducted in developing countries have shown that the cost of care during childbirth is a major factor for the utilization of maternal health services.[7] It is important to assess maternal satisfaction with care in order to make it more responsive and culturally
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