Sunny Avinash K, Basnet Omkar, Acharya Ankit, Poudel Prajwal, Malqvist Mats, Kc Ashish
Golden Community, Lalitpur, Nepal.
Ministry of Health and Population, Kathmandu, Nepal.
BMC Health Serv Res. 2021 Feb 8;21(1):128. doi: 10.1186/s12913-021-06125-9.
Sustainable Development Goal (SDG) aspires to improve universal health coverage through reduction of Out of Pocket Expenditure (OOPE) and improving the quality of care. In the last two decades, there have been several efforts to reduce the OOPE for maternal and newborn care. In this paper, we evaluate the change in the OOPE for treatment of sick newborn at hospital before and after implementation of a free newborn care (FNC) program in hospitals of Nepal.
Ministry of Health and Population implemented a free newborn care program which reimbursed the cost of treatment for all sick newborns admitted in public hospitals in Nepal from November 2017. We conducted this pre-post quasi-experimental study with four months of pre-implementation and 12 months of post-implementation of the program in 12 hospitals of Nepal. Logistic regression analysis was conducted for categorical variables and Mann-Whitney test was applied for continuous variables to determine statistically significant differences between pre- and post- intervention period.
A total of 353 sick newborns were admitted into these hospitals before implementation of the FNC program while 1122 sick newborns were admitted after the implementation. Before implementation, 17 % of mothers paid for sick newborn care while after implementation 15.3 % mothers (p-value = 0.59) paid for care. The OOPE for treatment of sick newborn at hospital before implementation was Mean ± SD: US dollar 14.3 + 12.1 and after implementation was Mean ± SD: USD 13.0 ± 9.6 (p-value = 0.71). There were no significant differences in neonatal morbidity after the implementation of the FNC program. The stay in a hospital bed (in days) decreased after the implementation of FNC program (p-value < 0.001) while the cost for medicine increased (p-value = 0.02). The duration of hospital stay (in days) of sick newborns significantly decreased for Hypoxic Ischemic Encephalopathy (HIE) (p-value = 0.04) and neonatal sepsis (p-value < 0.001) after the FNC program was implemented.
We found no change in the OOPE for sick newborn care following implementation of the FNC Program. There is a need to revisit the FNC program by the type of morbidity and duration of stay. Further studies will be required to explore the health system adequacy to implement such programs in hospitals of Nepal.
ISRCTN- 30829654 , Registered on May 02, 2017.
可持续发展目标（SDG）旨在通过减少自付费用（OOPE）和提高医疗质量来改善全民健康覆盖。在过去二十年中，为减少孕产妇和新生儿护理的自付费用做出了多项努力。在本文中，我们评估了尼泊尔医院实施免费新生儿护理（FNC）计划前后，患病新生儿住院治疗自付费用的变化。
尼泊尔卫生与人口部实施了一项免费新生儿护理计划，自2017年11月起，该计划为尼泊尔公立医院收治的所有患病新生儿报销治疗费用。我们在尼泊尔的12家医院开展了这项前后对照的准实验研究，计划实施前为期四个月，实施后为期12个月。对分类变量进行逻辑回归分析，对连续变量应用曼-惠特尼检验，以确定干预前后时期之间的统计学显著差异。
在FNC计划实施前，共有353名患病新生儿入住这些医院，实施后有1122名患病新生儿入住。实施前，17%的母亲为患病新生儿护理付费，实施后为15.3%的母亲（p值 = 0.59）为护理付费。实施前，患病新生儿住院治疗的自付费用均值±标准差为14.3 + 12.1美元，实施后为13.0 ± 9.6美元（p值 = 0.71）。FNC计划实施后，新生儿发病率没有显著差异。FNC计划实施后，住院天数（天）减少（p值 < 0.001），而药品费用增加（p值 = 0.02）。FNC计划实施后，缺氧缺血性脑病（HIE）（p值 = 0.04）和新生儿败血症（p值 < 0.001）的患病新生儿住院天数显著减少。
我们发现实施FNC计划后，患病新生儿护理的自付费用没有变化。有必要根据发病率类型和住院时间重新审视FNC计划。需要进一步研究以探讨尼泊尔医院实施此类计划的卫生系统充足性。
ISRCTN - 30829654，于2017年5月2日注册。
