Goli Srinivas, Rammohan Anu
Room, 102 Centre for the Study of Regional Development (CSRD), School of Social Sciences (SSS), Jawaharlal Nehru University (JNU), New Delhi, India.
Discipline of Economics, University of Western Australia, M251, 35 Stirling Highway, Crawley, WA, 6009, Australia.
Health Econ Rev. 2018 Feb 27;8(1):5. doi: 10.1186/s13561-018-0189-3.
The studies measured Out-of-Pocket Expenditure (OOPE) for hospital births previously suffer from serious data limitations. To overcome such limitations, we designed a hospital-based study for measuring the levels and factors of OOPE on maternity care for hospital births by its detailed components.
Data were collected from women for non-complicated deliveries 24-h before the survey and complicated deliveries 48-h prior to the survey at the hospital settings in Uttar Pradesh, India during 2014. The simple random sampling design was used in the selection of respondents. Bivariate analyses were used to estimate mean expenditure on Antenatal care services (ANCs), Delivery care and Total Maternity Expenditure (TME). Multivariate linear regression was employed to examine the factor associated with the absolute and relative share of expenditure in couple's annual income on ANCs, delivery care, and TME.
The findings show that average expenditure on maternal health care is high ($155) in the study population. Findings suggest that factors such as income, place, and number of ANCs, type, and place of institutional delivery are significantly associated with both absolute and relative expenditure on maternity care. The likelihood of incidence of catastrophic expenditure on maternity care is significantly higher for women delivered in private hospitals (β = 2.427, p < 0.001) compared to the government hospital (β = 0). Also, it is higher among caesarean or forceps deliveries (β = 0.617, p < 0.01), deliveries conducted on doctor advise (β = 0.598, p < 0.01), than in normal deliveries (β = 0) and self or family planned deliveries (β = 0).
The findings of this study suggest that the OOPE on maternity care for hospital births reported in this study is much higher as it was collected with a better methodology, although with smaller sample size. Therefore, ongoing maternity benefit scheme in India in general and Uttar Pradesh in particular need to consider the levels of OOPE on maternity care and demand-side and supply-side factors determining it for a more effective policy to reduce the catastrophic burden on households and help women to achieve better maternity health outcomes in poor regional settings like Uttar Pradesh in India.
先前有关医院分娩自付费用（OOPE）的研究存在严重的数据局限性。为克服这些局限性，我们设计了一项基于医院的研究，通过其详细组成部分来衡量医院分娩孕产妇保健自付费用的水平及影响因素。
2014年期间，在印度北方邦的医院环境中，于调查前24小时收集顺产妇女的数据，以及调查前48小时收集难产妇女的数据。采用简单随机抽样设计选取受访者。双变量分析用于估计产前保健服务（ANC）、分娩护理及孕产妇总支出（TME）的平均费用。采用多元线性回归分析与夫妇年收入中ANC、分娩护理及TME支出的绝对和相对份额相关的因素。
研究结果表明，研究人群中孕产妇保健的平均费用较高（155美元）。研究结果表明，诸如收入、地点、产前检查次数、机构分娩的类型和地点等因素与孕产妇保健的绝对和相对支出均显著相关。与政府医院（β = 0）相比，在私立医院分娩的妇女发生孕产妇保健灾难性支出的可能性显著更高（β = 2.427，p < 0.001）。此外，剖宫产或产钳分娩（β = 0.617，p < 0.01）、遵医嘱分娩（β = 0.598，p < 0.01）的妇女发生灾难性支出的可能性高于顺产（β = 0）和自行或家庭计划分娩（β = 0）的妇女。
本研究结果表明，尽管样本量较小，但由于采用了更好的方法收集数据，本研究报告的医院分娩孕产妇保健自付费用要高得多。因此，印度总体上尤其是北方邦正在实施的孕产妇福利计划需要考虑孕产妇保健自付费用的水平以及决定该费用的需求侧和供给侧因素，以便制定更有效的政策，减轻家庭的灾难性负担，并帮助印度北方邦等贫困地区的妇女实现更好的孕产妇健康结局。
