Kc Ashish, Målqvist Mats, Bhandari Amit, Gurung Rejina, Basnet Omkar, Sunny Avinash K
Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden.
Society of Public Health Physicians Nepal, Kathmandu, Nepal.
Arch Public Health. 2021 Sep 9;79(1):163. doi: 10.1186/s13690-021-00680-7.
Since the Millennium Development Goal era, there have been several efforts to increase institutional births using demand side financing. Since 2005, Government of Nepal has implemented Maternity Incentive Scheme (MIS) to reduce out of pocket expenditure (OOPE) for institutional birth. We aim to assess OOPE among women who had institutional births and coverage of MIS in Nepal.
We conducted a prospective cohort study in 12 hospitals of Nepal for a period of 18 months. All women who were admitted in the hospital for delivery and consented were enrolled into the study. Research nurses conducted pre-discharge interviews with women on costs paid for medical services and non-medical services. We analysed the out of pocket expenditure by mode of delivery, duration of stay and hospitals. We also analysed the coverage of maternal incentive scheme in these hospitals.
Among the women (n-21,697) reporting OOPE, the average expenditure per birth was 41.5 USD with 36 % attributing to transportation cost. The median OOPE was highest in Bheri hospital (60.3 USD) in comparison with other hospitals. The OOPE increased by 1.5 USD (1.2, 1.8) with each additional day stay in the hospital. There was a difference in the OOPE by mode of delivery, duration of hospital-stay and hospital of birth. The median OOPE was high among the caesarean birth with 43.3 USD in comparison with vaginal birth, 32.6 USD. The median OOPE was 44.7 USD, if the women stayed for 7 days and 33.5 USD if the women stayed for 24 h. The OOPE increased by 1.5 USD with each additional day of hospital stay after 24 h. The coverage of maternal incentive was 96.5 % among the women enrolled in the study.
Families still make out of pocket expenditure for institutional birth with a large proportion attributed to hospital care. OOPE for institutional births varied by duration of stay and mode of birth. Given the near universal coverage of incentive scheme, there is a need to review the amount of re-imbursement done to women based on duration of stay and mode of birth.
自千年发展目标时代以来，人们为通过需求侧融资增加机构分娩做出了多项努力。自2005年以来，尼泊尔政府实施了产妇激励计划（MIS），以减少机构分娩的自付费用（OOPE）。我们旨在评估尼泊尔机构分娩妇女的自付费用以及MIS的覆盖情况。
我们在尼泊尔的12家医院进行了为期18个月的前瞻性队列研究。所有入院分娩并同意参与的妇女均纳入研究。研究护士在妇女出院前就医疗服务和非医疗服务的支付费用进行访谈。我们按分娩方式、住院时间和医院分析了自付费用。我们还分析了这些医院中产妇激励计划的覆盖情况。
在报告有自付费用的妇女（n = 21,697）中，每次分娩的平均支出为41.5美元，其中36%归因于交通费用。与其他医院相比，贝里医院的自付费用中位数最高（60.3美元）。住院时间每增加一天，自付费用增加1.5美元（1.2，1.8）。自付费用在分娩方式、住院时间和分娩医院方面存在差异。剖宫产的自付费用中位数较高，为43.3美元，而阴道分娩为32.6美元。如果妇女住院7天，自付费用中位数为44.7美元；如果妇女住院24小时，自付费用中位数为33.5美元。住院24小时后，住院时间每增加一天，自付费用增加1.5美元。参与研究的妇女中产妇激励计划的覆盖率为96.5%。
家庭仍需为机构分娩支付自付费用，其中很大一部分归因于医院护理。机构分娩的自付费用因住院时间和分娩方式而异。鉴于激励计划几乎全面覆盖，有必要根据住院时间和分娩方式审查向妇女支付的报销金额。
