Tripathy Jaya Prasad, Shewade Hemant D, Mishra Sanskruti, Kumar A M V, Harries A D
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, C-6, Qutub Institutional Area, New Delhi, 110016, India.
Independent Public Health Consultant, New Delhi, India.
BMC Res Notes. 2017 Aug 15;10(1):409. doi: 10.1186/s13104-017-2729-z.
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. We undertook this study to evaluate the OOP expenditure due to hospitalization from childbirth and its impact on households.
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.
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.
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.
为了做出合理决策以提高孕产妇护理服务的可负担性，需要了解印度公立和私立医疗机构分娩时的自付费用情况。我们开展了这项研究，以评估分娩住院导致的自付费用及其对家庭的影响。
这是对2014年全国抽样调查组织进行的一项全国家庭调查的二次数据分析。该调查报告了按收入五分位数和医疗机构类型划分的卫生服务利用情况及与医疗保健相关的支出。住院支出的回忆期为365天。自付费用超过年度消费支出10%的被称为灾难性支出。
分娩导致的每次住院支出中位数为54美元。最富有的五分位数人群的支出比最贫穷的五分位数人群高出约六倍。私营部门的自付住院支出中位数比公共部门高出近九倍。在私立医疗机构住院导致灾难性支出的发生率显著高于在公立医疗机构住院（60%对7%）。间接成本（43%）在公共部门住院总支出中占比最大。城市居住、财富五分位数低、居住在印度东部和南部地区以及在私立医院分娩与灾难性支出显著相关。
我们强烈建议实施有效的扶贫定向现金转移计划，以减少灾难性支出的影响。需要加强公共卫生设施建设并对私营部门进行监管。
