Comparative analysis of caesarean delivery among out-of-pocket and health insurance clients in Ilorin, Nigeria.

BACKGROUND

Although out-of-pocket (OOP) payment for health services is common, information on the experience in maternal health services especially caesarean delivery (CD) is limited.

AIM

To compare the pregnancy events and financial transactions for CD among OOP and health-insured clients.

MATERIALS AND METHODS

A comparative (retrospective) study of 200 women who had CD as OOP (100 participants) or health-insured clients (100 participants) over 30 months at Anchormed Hospital, Ilorin, using multistage sampling was conducted. The data were analysed using Chi-square, t-test and regression analysis; P < 0.05 was considered statistically significant.

RESULTS

Of 1246 deliveries, 410 (32.9%) had CD; of these, 186 (45.4%) were health-insured and 224 (54.6%) were OOP payers. The health-insured were mostly civil servants (60.0% vs. 40.0%; P = 0.009) of high social class (48.0% vs. 29.0%; P = 0.001). The payment for CD was higher among OOP (P = 0.001), whereas duration from hospital discharge to payment of hospital bill was higher for the health-insured (P = 0.001). On regression, social class (odds ratio [OR]: 0.23, 95% confidence interval [CI]: -0.0891252-0.112799; P = 0.048), amount paid (OR: 48.52, 95% CI: -7.14-6.68; P = 0.001) and duration from discharge to payment (OR: 28.68, 95% CI: 51.7816-70.788; P = 0.001) were statistically significant among participants. The amount paid was lower (P = 0.001), whereas time interval before payment was longer (P = 0.001) for the public-insured compared to private-insured clients.

CONCLUSION

OOP payers are prone to catastrophic spending on health. The waiting time before reimbursement to health-care providers was significantly prolonged; private insurers offered earlier and higher reimbursement compared to public insurers. The referral and transportation of health-insured clients during emergencies is suboptimal and deserve attention.