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Does choice of health care facility matter? Assessing out-of-pocket expenditure and catastrophic spending on emergency obstetric care in India

Published online by Cambridge University Press:  25 June 2020

Jalandhar Pradhan Open the ORCID record for Jalandhar Pradhan [Opens in a new window]  and
Sasmita Behera
Jalandhar Pradhan*
Affiliation:
Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, India
Sasmita Behera
Affiliation:
Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, India
*
*Corresponding author. Email: [email protected]
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Abstract

The key recommendation of the Child Survival and Safe Motherhood programme was the provision of Emergency Obstetric Care (EmOC) for the prevention of maternal mortality, especially in developing countries like India. The objectives of this paper were three-fold: to examine the socioeconomic differentials in mean out-of-pocket expenditure on EmOC in public and private health care facilities in India; to evaluate the catastrophic health expenditure of households at the threshold levels of 5% and 10%; and finally, to assess the effects of various socioeconomic and demographic covariates on the levels of catastrophic health expenditure on EmOC. Data were extracted from the 71st round of the National Sample Survey Office (NSSO) survey conducted in India between January and June 2014. A stratified multi-stage sampling design was followed to conduct the survey. The information was collected from 65,932 households (rural: 36,480; urban: 29,452) and 33,104 individuals across various states and union territories in India. However, the present study had taken only 1653 sample women who availed EmOC care during the last one year preceding the survey date. Binary logistic regression was applied. Large differences in out-of-pocket expenditure on EmOC were found between private and public health care facilities. Mean annual out-of-pocket expenditure by women in private hospitals was INR 23,309 (US$367), which was about 6 times higher than in public hospitals, where mean spending was INR 3651 (US$58). Furthermore, logistic regression analysis showed a significant association between household socioeconomic status and level of catastrophic health expenditure on EmOC. The odds of catastrophic health expenditure in public health facilities among women from the North region were higher than among those from the Central, South and West regions. Age and level of education significantly influenced the mean level of catastrophic health expenditure. Access to good-quality obstetric care is key to reducing the maternal mortality rate and child deaths, and thus achieving Sustainable Development Goal 3. There is an urgent need for policy interventions to reduce the financial burden of households in accessing obstetric care in India.

Keywords

Catastrophic health expenditureObstetric careIndia
Type
Research Article
Information
Journal of Biosocial Science , Volume 53 , Issue 4 , July 2021 , pp. 481 - 496
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Arsenault, C, Fournier, P, Philibert, A, Sissoko, K, Coulibaly, A, Tourigny, C and Dumont, A (2013) Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households. Bulletin of the World Health Organization 91(3), 207–216.CrossRefGoogle ScholarPubMed
Atuoye, KN, Dixon, J, Rishworth, A, Galaa, SZ, Boamah, SA and Luginaah, I (2015) Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana. BMC Health Services Research 15(1), 333.CrossRefGoogle ScholarPubMed
Belda, SS and Gebremariam, MB (2016) Birth preparedness, complication readiness and other determinants of place of delivery among mothers in Goba District, Bale Zone, South East Ethiopia. BMC Pregnancy and Childbirth 16(1), 73.CrossRefGoogle ScholarPubMed
Berhan, Y and Berhan, A (2014) Antenatal care as a means of increasing birth in the health facility and reducing maternal mortality: a systematic review. Ethiopian Journal of Health Sciences 24, 93–104.CrossRefGoogle ScholarPubMed
Bhate-Deosthali, P, Khatri, R and Wagle, S (2011) Poor standards of care in small, private hospitals in Maharashtra, India: implications for public–private partnerships for maternity care. Reproductive Health Matters 19(37), 32–41.CrossRefGoogle ScholarPubMed
Bhatia, MR, Yesudian, CA, Gorter, A and Thankappan, KR (2006) Demand side financing for reproductive and child health services in India. Economic and Political Weekly 41(3), 279–284.Google Scholar
Bhattacharya, G and Haldar, SK (2014) Trend, differential and determinants of deprivation of reproductive and child health in the districts of West Bengal, India. Journal of Health Management 16(1), 93–112.CrossRefGoogle Scholar
Bhojani, U, Thriveni, BS, Devadasan, R, Munegowda, CM, Devadasan, N, Kolsteren, P and Criel, B (2012) Out-of-pocket healthcare payments on chronic conditions impoverish urban poor in Bangalore, India. BMC Public Health 12(1), 990.CrossRefGoogle ScholarPubMed
Birmeta, K, Dibaba, Y and Woldeyohannes, D (2013) Determinants of maternal health care utilization in Holeta town, central Ethiopia. BMC Health Services Research 13(1), 256.CrossRefGoogle ScholarPubMed
Biswas, AB, Das, DK, Misra, R, Roy, RN, Ghosh, D and Mitra, K (2005) Availability and use of emergency obstetric care services in four districts of West Bengal, India. Journal of Health, Population and Nutrition 23(3), 266–274.Google ScholarPubMed
Bonu, S, Bhushan, I, Rani, M and Anderson, I (2009) Incidence and correlates of ‘catastrophic’ maternal health care expenditure in India. Health Policy and Planning 24(6), 445–456.CrossRefGoogle ScholarPubMed
Browne, JL, Kayode, GA, Arhinful, D, Fidder, SA, Grobbee, DE and Klipstein-Grobusch, K (2016) Health insurance determines antenatal, delivery and postnatal care utilisation: evidence from the Ghana Demographic and Health Surveillance data. BMJ Open 6(3), e008175.CrossRefGoogle ScholarPubMed
Campbell, OM, Graham, WJ and Lancet Maternal Survival Series Steering Group (2006) Strategies for reducing maternal mortality: getting on with what works. The Lancet 368(9543), 1284–1299.CrossRefGoogle Scholar
Das, R and Biswas, S (2015) Eclapmsia: the major cause of maternal mortality in Eastern India. Ethiopian Journal of Health Sciences 25(2), 111–116.CrossRefGoogle ScholarPubMed
Ganatra, BR, Coyaji, KJ and Rao, VN (1998) Too far, too little, too late: a community-based case-control study of maternal mortality in rural west Maharashtra, India. Bulletin of the World Health Organization 76(6), 591.Google ScholarPubMed
George, A (2007) Persistence of high maternal mortality in Koppal district, Karnataka, India: observed service delivery constraints. Reproductive Health Matters 15(30), 91–102.CrossRefGoogle ScholarPubMed
Gerein, N, Green, A and Pearson, S (2006) The implications of shortages of health professionals for maternal health in sub-Saharan Africa. Reproductive Health Matters 14(27), 40–50.CrossRefGoogle ScholarPubMed
Ghosh, S (2011) Catastrophic payments and impoverishment due to out-of-pocket health spending. Economic and Political Weekly 46(47) 63–70.Google Scholar
Goli, S, Moradhvaj, , Anu, R, Shruti, and Pradhan, J (2016) High spending on maternity care in India: what are the factors explaining it? PLoS One 11(6), e0156437.CrossRefGoogle Scholar
Griffiths, P and Stephenson, R (2001) Understanding users’ perspectives of barriers to maternal health care use in Maharashtra, India. Journal of Biosocial Science, 33(3), 339–359.CrossRefGoogle ScholarPubMed
Iyengar, K and Iyengar, SD (2000) Reproductive Health on the Ground. Action Research and Training for Health, Udaipur.Google Scholar
Kerketta, S (2015) Out of pocket expenditure on utilization of ante-natal and delivery care services in India: analysis based on NSSO 60th round. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 4(6), 1704–1709.CrossRefGoogle Scholar
Keya, KT, Rob, U, Rahman, MM, Bajracharya, A and Bellows, B (2014) Distance, transportation cost, and mode of transport in the utilization of facility-based maternity services: evidence from rural Bangladesh. International Quarterly of Community Health Education 35(1), 37–51.CrossRefGoogle ScholarPubMed
Khosla, AH, Dahiya, K and Sangwan, K (2000) Maternal mortality and ‘near-miss’ in rural north India. International Journal of Gynecology and Obstetrics 68(2), 163–164.CrossRefGoogle ScholarPubMed
Leone, T, James, KS and Padmadas, SS (2013) The burden of maternal health care expenditure in India: multilevel analysis of national data. Maternal and Child Health Journal 17(9), 1622–1630.CrossRefGoogle ScholarPubMed
Mateen, A, Shaikh, BT and Kumar, R (2013) Emergency obstetrics care services in District Neelum, Azad Jammu and Kashmir. Journal of Ayub Medical College Abbottabad 25(1–2), 194–197.Google ScholarPubMed
Mavalankar, DV (2001) Policy Barriers Preventing Access to Emergency Obstetric Care in Rural India. Working Paper. URI: http://hdl.handle.net/11718/20525 Google Scholar
Mishra, V and Retherford, RD (2008) The effect of antenatal care on professional assistance at delivery in rural India. Population Research and Policy Review 27(3), 307–320.CrossRefGoogle Scholar
Mohanty, SK (2012) Multiple deprivations and maternal care in India. International Perspectives on Sexual and Reproductive Health 38(1), 6–14.CrossRefGoogle ScholarPubMed
Mohanty, SK and Kastor, A (2017) Out-of-pocket expenditure and catastrophic health spending on maternal care in public and private health centres in India: a comparative study of pre and post national health mission period. Health Economics Review 7(1), 31.CrossRefGoogle ScholarPubMed
Mohanty, SK and Srivastava, A (2013) Out-of-pocket expenditure on institutional delivery in India. Health Policy and Planning 28(3), 247–262.CrossRefGoogle ScholarPubMed
Montgomery, AL, Ram, U, Kumar, R, Jha, P and Million Death Study Collaborators (2014) Maternal mortality in India: causes and healthcare service use based on a nationally representative survey. PLoS One 9(1), e83331.CrossRefGoogle Scholar
Mukherjee, S, Singh, A and Chandra, R (2013) Maternity or catastrophe: a study of household expenditure on maternal health care in India. Health 5(1), 109–118.CrossRefGoogle Scholar
NHSRC (2018) National Health Accounts Estimates for India (2015–16). National Health Systems Resource Centre, Ministry of Health and Family Welfare, Government of India, New Delhi.Google Scholar
NSSO (2015) Key Indicators of Social Consumption in India: Health (NSSO 71st Round, January–June 2014). National Sample Survey Office Ministry of Statistics and Programme Implementation (MOSPI), Government of India. URL: http://mail.mospi.gov.in/index.php/catalog/161/download/1949.Google Scholar
Origlia, P, Jevitt, C, Sayn-Wittgenstein, FZ and Cignacco, E (2017) Experiences of antenatal care among women who are socioeconomically deprived in high-income industrialized countries: an integrative review. Journal of Midwifery and Women’s Health 62(5), 589–598.CrossRefGoogle Scholar
Paul, P and Chouhan, P (2020) Socio-demographic factors influencing utilization of maternal health care services in India. Clinical Epidemiology and Global Health, doi:https://doi.org/10.1016/j.cegh.2019.12.023 CrossRefGoogle Scholar
Pradhan, J and Dwivedi, R (2017) Do we provide affordable, accessible and administrable health care? An assessment of SES differential in out of pocket expenditure on delivery care in India. Sexual and Reproductive Healthcare 11, 69–78.CrossRefGoogle ScholarPubMed
Prakasamma, M (2009) Maternal mortality-reduction programme in Andhra Pradesh. Journal of Health Population and Nutrition 27(2), 220–234.CrossRefGoogle ScholarPubMed
Rahman, MM, Rob, U, Noor, FR and Bellows, B (2013) Out-of-pocket expenses for maternity care in rural Bangladesh: a public–private comparison. International Quarterly of Community Health Education 33(2), 143–157.CrossRefGoogle Scholar
RGI (2019) Special Bulletin on Maternal Mortality in India 2015–2017.: Office of the Registrar General, New Delhi,Google Scholar
Sharma, S, Verma, PB, Viramgami, AP, Vala, MC and Lodhiya, KK (2018) Analysis of out-of-pocket expenditure in utilization of maternity care services in urban slums of Rajkot City, Gujarat. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive and Social Medicine 43(3), 215.Google ScholarPubMed
Sikder, SS, Labrique, AB, Craig, IM, Wakil, MA, Shamim, AA, Ali, H and Christian, P (2015) Patterns and determinants of care seeking for obstetric complications in rural northwest Bangladesh: analysis from a prospective cohort study. BMC Health Services Research 15(1), 166.CrossRefGoogle ScholarPubMed
Singh, A, Mavalankar, DV, Bhat, R, Desai, A, Patel, SR, Singh, PV and Singh, N (2009) Providing skilled birth attendants and emergency obstetric care to the poor through partnership with private sector obstetricians in Gujarat, India. Bulletin of the World Health Organization 87, 960–964 CrossRefGoogle ScholarPubMed
Tibandebage, P, Kida, T, Mackintosh, M and Ikingura, J (2016) Can managers empower nurse-midwives to improve maternal health care? A comparison of two resource-poor hospitals in Tanzania. International Journal of Health Planning and Management 31(4), 379–395.CrossRefGoogle ScholarPubMed
Wagstaff, A, Eozenou, PH-V and Smitz, M-F (2019) Out-of-Pocket Expenditures on Health: A Global Stocktake (English). Policy Research Working Paper No. WPS 8808. World Bank Group, Washington, DC.CrossRefGoogle Scholar
Wang, W, Temsah, G and Mallick, L (2017) The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda. Health Policy and Planning 32(3), 366–375.Google ScholarPubMed
WHO (2019) Trends in Maternal Mortality 2000 to 2017. Estimates by WHO, UNICEF, UNFPA, World Bank Group and United Nations Population Division, Geneva.Google Scholar
WHO (2005) Distribution of Health Payments and Catastrophic Expenditures Methodology. No. EIP/FER/DP. 05.2. World Health Organization, Geneva.Google Scholar
WHO (2013) Maternal Death Surveillance and Response: Technical Guidance Information for Action to Prevent Maternal Death. WHO, Geneva.Google Scholar
Xu, K, Evans, DB, Kawabata, K, Zeramdini, R, Klavus, J and Murray, CJ (2003) Household catastrophic health expenditure: a multicountry analysis. The Lancet 362(9378), 111–117.CrossRefGoogle ScholarPubMed