Cost of hospitalization for childbirth in India: how equitable it is in the post-NRHM era?
Evaluates the out-of-pocket expenditure due to hospitalization from childbirth and its impact on households
Abstract
Background and objective
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 authors undertook this study to evaluate the OOP expenditure due to hospitalization from childbirth and its impact on households.
Methods
This 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.
Results
Median 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.
Conclusions
We 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.
This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)
Citation
Tripathy JP, Shewade HD, Mishra S, Kumar AM V, Harries AD. Cost of hospitalization for childbirth in India : how equitable it is in the post ‑ NRHM era ? BMC Research Notes. 2017;10(1):409.
Links
Cost of hospitalization for childbirth in India: how equitable it is in the post-NRHM era?