Out-of-pocket expenditure for delivery at home and public health facilities in the context of conditional cash transfer and free delivery care programs: An analytical cross-sectional study in South 24 Parganas district, West Bengal, India, 2017

Abstract

BackgroundThe Indian government provides for free/subsidized services in public hospitals and conditional cash transfer (CCT) schemes for delivery care. Our objectives were to estimate the proportion of women reporting out-of-pocket expenditure (OOPE) for delivery care at home and public hospitals, magnitude of components of OOPE for public hospitals by wealth status, and to determine the factors associated with OOPE for delivery care at home and public hospitals in South 24 Parganas district. MethodsWe did a community based cross-sectional analytical study among women who delivered between November 2016 to March 2017. We calculated median (Inter-Quartile Range) direct and indirect expenditures. We did multiple logistic regression to calculate odds ratios (95% confidence interval). ResultsAll women reported OOPE for delivery care. Median OOPE was INR 865 (IQR: 520,1700) at public hospital and INR 1700 (IQR: 550,2300) at home. Among public hospital deliveries, majority of OOPE was due to indirect expenditure, 35.8% due to wage loss. Poorest women had the highest median gross OOPE. The middle-income group had the highest median percentage of reduction in OOPE for home delivery after receiving government subsidy. OOPE was most likely for a male child (OR 4.8, 95% CI 1.1–2.0) for home delivery and for caesarian section (OR 56.8, 95% CI 13.6–237) among the public hospital deliveries. ConclusionsWomen incurred OOPE for delivery care at home and public hospitals despite free/subsidized care. Augmenting the package of delivery-related CCT schemes and increase in universal health insurance coverage for economically poor households can reduce the financial burden of delivery care in the district.