Distress financing in coping with out-of-pocket expenditure for maternity care in India

Abstract

Background The cost of maternity care is seen as the barrier in utilizing maternity care, resulting in high maternal deaths. This study focuses on the distress financing and its coping mechanisms associated with maternity care expenditure in India so that corrective measures can be taken to reduce the burden of maternity care. Methods This study used the National Sample Survey (NSS) data conducted in 20,014–15 (71st round of NSS) and 2017–18(75th round of NSS). We define distress financing as use of formal borrowing, borrowing from friends or family or sale of asser to finance maternity care. Percentage of pregnant/delivered females using distress financing were calculated.. The present study also used multinomial logistic regression with 95% to understand the impact of socio-economic variables on distress financing and concentration index to measure the inequality in maternity care expenditure. Results This study found that the maternity care expenditure has decreased from the INR. 9379 in 2014–15 to INR. 7835 in 2017–18. The percentage of households using distress financing is higher among the poorest (13.2%). Almost 14% of the SC households experience distress financing. Among EAG + A states, particularly in Madhya Pradesh and Uttarakhand, the percentage of households are which experience a high level of distress financing increased from 8.9 to 18.3 and 0.7 to 8.1 from 2014–15 to 2017–18 respectively. The study finds that more urban households (37%) utilized insurance than rural households (26%). Among EAG + A states, 67.9 percent of households were dependent upon household savings, and it was 63.6 percent in the non-EAG states. The households with a high burden of maternity care expenditure were at higher risk of borrowing money to finance the cost of maternity as compared to use of savings/income for the same (relative risk (RR) (R: 2.59; P < 0.01; 95% CI: 2.15–3.13). Mothers belonging to the SC caste were at significantly higher risk (RR: 1.43; P < 0.1; 95% CI: 1.07–1.91). of using borrowings as compared to the use of income/savings. Mothers with college education were 50% more likely to use health insurance as compared to those with primary education. Conclusions The study found that even though many programs for maternity care services are there, the maternity care expenditure, particularly the delivery care expenses, is very high in many states. The study recommends that India should increase subsidized maternity care facilities to decrease catastrophic maternity expenditure among households.

Examining the effect of removing banknotes and implementing Goods and Services Tax on access to healthcare in India

“…Banerjee and Chowdhury (2020) also reported a reduction in self-reported illness in the NSSO 2017-18 round compared to the round, though there was no explanation offered for this observation. Balla et al (2022) noticed a reduction in OOPE for maternity care in 2017-18 compared to 2014 but also did not explain this finding.…”

Out-of-pocket expenditure and its correlates for institutional deliveries in private and public healthcare sectors in India: findings from NFHS 5

“…Cleanliness, quality and rapid services, personal care, better doctor/nurse-to-patient ratio: such conceptions drive general people towards private institutions [ 20 ]. Day-by-day, cost of availing health care is increasing [ 20 ], so is willingness and ability to purchase, which steer a lofty chunk of our population in the direction to high out-of-pocket spending at private institutions [ 21 ]. OOPE was found to be more from both rural and urban private institutions, however, the median OOPE was less at rural private health facilities; probably due to pregnant women and/or their families were unable to avail healthcare services, so opting more for public institutions.…”

Examining the predictors of healthcare facility choice for outpatient care among older adults in India using Andersen’s revised healthcare utilization framework model

“…In developing nations like India, access to private healthcare facilities increases out-of-pocket expenses (OOPE), which traps lower and middle-income people in a vicious cycle of poverty [7]. A previous study suggests that the cost of healthcare services is four times higher in private facilities than in public facilities in India [5,8].…”

“…As a result, a substantial number of families experience distress financing when using profit-making healthcare facilities because a considerable number of households belongs to below the poverty line (BPL) and lower and middle socio-economic strata (SES) in India [6,9,10]. Health insurance coverage is also deficient in India, particularly among individuals belonging to the lower and middle SES [5,7,9]. For instance, only a quarter of households (26%) have health insurance, with 21% registered in the Rashtriya Swasthya Bima Yojana (RSBY), 2.4% in the Central Government Health Scheme, and only 1.4% in private health insurance [5].…”