Out-of-pocket expenditure and distress financing on institutional delivery in India

Mishra, Suyash; Mohanty, Sanjay K.

doi:10.1186/s12939-019-1001-7

Cited by 44 publications

(48 citation statements)

References 54 publications

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“…Studies show that the average delivery cost in the caesarean section is many times higher than the normal delivery. 25,26 Consistence to previous studies, this study also shows that the average caesarean delivery cost is almost double than non-caesarean delivery. In private hospitals, this difference is more than three times higher.…”

Section: Discussionsupporting

confidence: 72%

“…Study reveals that sometimes they had to borrow money or sell their assets to meet the delivery cost. 26 Moreover, the benefits of using caesarean sections are yet to be a debatable issue on maternal and child health perspectives. The findings in this study show that mean z-score concentrations on all the three anthropometric indicators of children (i.e., stunting, underweight, and wasting) were close to normal for the non-caesarean children than those of caesarean children.…”

Section: Discussionmentioning

confidence: 99%

“…Although West Bengal has progressed satisfactorily in several demographic indicators (e.g., fertility, mortality, and life expectancy) than many other states in India, the increasing use of C Sections in the state during the past decade has serious public health concerns. Considering the need to highlight the adverse consequences of C-Section delivery, several studies have been conducted on 'C-Sections and delivery costs' at the national level, 26,28,29 such kinds of studies are a handful in West Bengal. Further, most of these studies are based on hospital-specific data; 30 thus it does not generalize for the whole state.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence and determinants of the use of caesarean section (CS) in the dichotomy of ‘public’ and ‘private’ health facilities in West Bengal. India

Sarkar

2020

Clinical Epidemiology and Global Health

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence and determinants of the use of caesarean section (CS) in the dichotomy of ‘public’ and ‘private’ health facilities in West Bengal. India

Sarkar

2020

Clinical Epidemiology and Global Health

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“…Although health system depends on state policy, reproductive services including antenatal care and delivery are provided mostly for free or at nominal cost in public health centers in India [ 15 ]. On the other hand, patients have to pay a significant amount of out-of-pocket (OOP) cost in private facilities because the governments neither regulate the service-fee charged by private providers nor do they support the cost for service utilization in the private facilities except for some empanelled ones in special government schemes such as Ayushman Bharat or Janani Suraksha Yojana (JSY) that aim to ensure accessibility to the health service of the poor and the vulnerable [ 16 ]. Therefore, there is a big gap in OOP expenditure for C-section between public and private facilities [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Association between the type of provider and Cesarean section delivery in India: A socioeconomic analysis of the National Family Health Surveys 1999, 2006, 2016

Lee

Kim

et al. 2021

PLoS ONE

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Background Prevalence of Cesarean section (C-section) is unequally distributed. Since both extremely low and high levels of C-section can not only cause adverse birth outcomes but also impose a double burden of inefficiency within maternal health care, it is important to monitor the dynamics of key factors associated with the use of C-section. Objectives To examine the association between type of provider and C-section in India in three-time points: 1999, 2006, and 2016, and also to assess whether this association differed across maternal education and wealth level. Methods Data were from three waves of cross-sectional and nationally representative Indian National Health Family Survey: Wave II (1999), III (2006), and IV (2016). Target population is women aged 15 and 49 who had an institutional delivery for the most recent live birth during the three or five years preceding the survey (depending on the survey round). Multivariate logistic regression models adjusting for state cluster effect were performed to determine the association between the type of providers and C-section. Differential association between the type of providers and C-section by maternal education and wealth level was examined by stratified analyses. Results The prevalence of C-section among institutional delivery increased from 20.5% in 1999 to 24.8% in 2006 while it declined to 19.4% in 2016. The positive association between private providers and C-section became stronger over the study period (Odds Ratio (OR) = 1.39, 95% Confidence Interval (CI) 1.18–1.64 in 1999, OR = 3.71 95% CI 2.93–4.70 in 2016). The association was consistently significant across all states in 2016. The gap in C-section between public and private providers was greater among less-educated and poorer women. The ORs gradually increased from the poorest to the richest quintiles, and also from the least educated group (no formal education) to the most educated group (college graduate or above) Conclusions Our results suggest that disparity in C-section between private and public providers has increased over the last 15 years and was higher in lower SES women. The behavior of providers needs to be closely monitored to ensure that C-section is performed only when medically justified.

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“…Incidence of CHE25 in 2017 was nine times greater in private sector than in public sector. Studies in India and several LMICs have reported that OOPE was greater for private sector utilization, including for in-patient care [13,20,32,49,[58][59][60][61][62][63].…”

Section: Discussionmentioning

confidence: 99%

Assessing the Pattern of Utilisation and Out of Pocket Expenditure in Public and Private Hospitals in India – Lessons for Universal Health Coverage from the Healthcare Rounds of National Sample Survey 1996 to 2017

Garg

Bebarta

Tripathi

2020

Preprint

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Introduction: Out of Pocket Expenditure (OOPE) contributes to impoverishment and Catastrophic Health Expenditure (CHE) and restricts equitable access to healthcare in many Low and Medium Income Countries (LMICs), including India. Indian government has implemented different strategies to expand access and to reduce OOPE in public and private hospitals in its mixed healthcare system. The study aims to assess the long-term pattern of utilization, OOPE and CHE in public and private hospitals and to draw policy lessons for Universal Health Coverage in India. Methods: Indian government conducts periodic household surveys called National Sample Survey (NSS). Unit data from the last four rounds of NSS (1996 to 2017) on healthcare utilization were analysed. Multivariate analysis was used to find out determinants of utilization, choice of provider, OOPE and CHE. Propensity Score Matching was applied to find effect of specific variables on OOPE and CHE. Results: The share of public-sector in hospital-utilisation fell from 1996 to 2004 but grew consistently after 2004, reaching 51% of utilization in 2017. Socio-economically vulnerable sections were more likely to utilize public-sector. Mean OOPE per hospitalization in public-sector registered a decline from 2004 to 2017, while it increased substantially in private-sector. OOPE in private sector was around six times greater than public sector in 2017 and incidence of CHE was nine times. Utilising private-sector was an important determinant of incurring CHE. Coverage under publicly funded insurance was ineffective in reducing OOPE or CHE. Discussion: Public sector provided effective protection to the poor from financial risk. While, the structural-adjustment policies of 1990s had resulted in reduction in public-sector utilisation, the supply-side strengthening of public sector after 2005 was more effective in improving access and financial-protection. For achieving UHC, Indian health-system needs increased public funding for strengthening public-sector, especially to provide services for NCDs and injuries. Persistently high OOPE in private-sector raises doubts whether public-funding or contracting can align provider incentives with goals of UHC. The debate on public-private provider mix and financing policies continues to hold relevance for health-systems performance across LMICs.

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Out-of-pocket expenditure and distress financing on institutional delivery in India

Cited by 44 publications

References 54 publications

Prevalence and determinants of the use of caesarean section (CS) in the dichotomy of ‘public’ and ‘private’ health facilities in West Bengal. India

Prevalence and determinants of the use of caesarean section (CS) in the dichotomy of ‘public’ and ‘private’ health facilities in West Bengal. India

Association between the type of provider and Cesarean section delivery in India: A socioeconomic analysis of the National Family Health Surveys 1999, 2006, 2016

Assessing the Pattern of Utilisation and Out of Pocket Expenditure in Public and Private Hospitals in India – Lessons for Universal Health Coverage from the Healthcare Rounds of National Sample Survey 1996 to 2017

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