Impoverishment and catastrophic expenditures due to out-of-pocket payments for antenatal and delivery care in Yangon Region, Myanmar: a cross-sectional study

Abstract

Objectives(1) To assess the levels of impoverishment and catastrophic expenditure due to out-of-pocket (OOP) payments for antenatal care (ANC) and delivery care in Yangon Region, Myanmar; and (2) to explore the determinants of impoverishment and catastrophic expenditure.Design, setting and participantsA community-based cross-sectional survey among women giving birth within the past 12 months in Yangon, Myanmar, was conducted during October to November 2016 using three-stage cluster sampling procedure.Outcome measuresPoverty headcount ratio, normalised poverty gap and catastrophic expenditure incidence due to OOP payments in the utilisation of ANC and delivery care as well as the determinants of impoverishment and catastrophic expenditure.ResultsOf 759 women, OOP payments were made by 75% of the women for ANC and 99.6% for delivery care. The poverty headcount ratios after payments increased to 4.3% among women using the ANC services, to 1.3% among those using delivery care and to 6.1% among those using both ANC and delivery care. The incidences of catastrophic expenditure after payments were found to be 12% for ANC, 9.1% for delivery care and 20.9% for both ANC and delivery care. The determinants of impoverishment and catastrophic expenditure were women’s occupation, number of household members, number of ANC visits and utilisation of skilled health personnel and health facilities. The associations of the outcomes with these variables bear both negative and positive signs.ConclusionsOOP payments for all ANC and delivery care services are a challenge to women, as one of fifteen women become impoverished and a further one-fifth incur catastrophic expenditures after visiting facilities that offer these services.

Cost of Treating Maternal Complications and Associated Factors in Mekelle General Hospital, Northern Ethiopia

“…Third, indirect cost estimates did not include intangible costs attributed to complication pain, psychological pressure, reduced joy of life and social prestige. Although such cost components are important, it is difficult to measure them and they are not usually included in health cost estimates (eg 20,28,30,31). Finally, even if various socioeconomic variables were controlled in the regression analysis, there could be still uncontrolled confounders that drive the outcome.…”

“…The existing studies mainly measure costs of maternal care based on direct out-of-pocket health expenditure and do not account for opportunity costs of seeking treatment. [18][19][20] Moreover, they did not investigate factors driving treatment costs. This study, therefore, aims to add knowledge to the literature by examining direct and indirect costs of treating maternal complications as well as associated factors in Northern Ethiopia.…”

Costs incurred and determinants of out‐of‐pocket payments for child delivery care in India: Evidence from a nationally representative household survey

“…This shows that the cost of delivery services has increased over the past decade. But the OOP cost of delivery care in our country is lesser than neighboring countries like Bangladesh and Myanmar . Coping mechanism employed by the majority of women to deal with OOP expenditure was borrowing of money from friends.…”

The Comparison of Out of Pocket Payments for Coronary Artery Bypass Graft Surgery Before and After the Health Sector Evolution Plan in the South of Iran

“…Evidence indicates that one of the barriers to health services access is the costs that patients have to pay (4)(5)(6). Meanwhile, OOP payment is the most common and the most important methods of financing in Asian countries and other developing countries (7). There are a large number of studies that show the distribution of OOP and their effect on impoverishment and household welfare (8,9).…”