Institute of Health Research, University of Health and Allied Sciences, Box 31, Ho, Ghana.
Social Science Department, Navrongo Health Research Centre, Box 114, Navrongo, Ghana.
BMC Pregnancy Childbirth. 2022 Aug 4;22(1):613. doi: 10.1186/s12884-022-04947-x.
Out-of-pocket payment (OOPP) is reported to be a major barrier to seeking maternal health care especially among the poor and can expose households to a risk of catastrophic expenditure and impoverishment.This study examined the OOPPs women made during childbirth in the Upper West region of Ghana.
We carried out a cross-sectional study and interviewed women who gave birth between January 2013 and December 2017. Data on socio-demographic characteristics, place of childbirth, as well as direct cost (medical and non-medical) were collected from respondents. The costs of childbirth were estimated from the patient perspective. Logistics regression was used to assess the factors associated with catastrophic payments cost. All analyses were done using STATA 16.0.
Out of the 574 women interviewed, about 71% (406/574) reported OOPPs on their childbirth. The overall average direct medical and non-medical expenditure women made on childbirth was USD 7.5. Cost of drugs (USD 8.0) and informal payments (UDD 5.7) were the main cost drivers for medical and non-medical costs respectively. Women who were enrolled into the National Health Insurance Scheme (NHIS) spent a little less (USD 7.5) than the uninsured women (USD 7.9). Also, household childbirth expenditure increased from primary health facilities level (community-based health planning and services compound = USD7.2; health centre = USD 6.0) to secondary health facilities level (hospital = USD11.0); while home childbirth was USD 4.8. Overall, at a 10% threshold, 21% of the respondents incurred catastrophic health expenditure. Regression analysis showed that place of childbirth and household wealth were statistically significant factors associated with catastrophic payment.
The costs of childbirth were considerably high with a fifth of households spending more than one-tenth of their monthly income on childbirth and therefore faced the risk of catastrophic payments and impoverishment. Given the positive effect of NHIS on cost of childbirth, there is a need to intensify efforts to improve enrolment to reduce direct medical costs as well as sensitization and monitoring to reduce informal payment. Also, the identified factors that influence cost of childbirth should be considered in strategies to reduce cost of childbirth.
据报道，自费支付（OOPP）是寻求产妇保健的主要障碍，尤其是在贫困人群中，这可能使家庭面临灾难性支出和贫困的风险。本研究调查了加纳上西部地区妇女在分娩期间的自费支付情况。
我们进行了一项横断面研究，采访了 2013 年 1 月至 2017 年 12 月期间分娩的妇女。从受访者那里收集了社会人口特征、分娩地点以及直接费用（医疗和非医疗）的数据。从患者角度估算了分娩费用。使用逻辑回归评估了与灾难性支付费用相关的因素。所有分析均使用 STATA 16.0 进行。
在接受采访的 574 名妇女中，约 71%（406/574）报告在分娩时自费支付。妇女在分娩方面的直接医疗和非医疗总支出平均为 7.5 美元。药品成本（8.0 美元）和非正式支付（5.7 美元）分别是医疗和非医疗费用的主要成本驱动因素。参加国家健康保险计划（NHIS）的妇女支出略低于未参保妇女（7.9 美元）。此外，家庭分娩支出从初级卫生设施水平（社区卫生规划和服务综合大楼=7.2 美元；卫生中心=6.0 美元）增加到二级卫生设施水平（医院=11.0 美元）；而在家分娩则为 4.8 美元。总体而言，在 10%的门槛下，21%的受访者发生了灾难性的医疗支出。回归分析表明，分娩地点和家庭财富是与灾难性支付相关的统计学显著因素。
分娩费用相当高，五分之一的家庭分娩支出超过其月收入的十分之一，因此面临灾难性支付和贫困的风险。鉴于 NHIS 对分娩费用的积极影响，需要加强努力，提高参保率，以降低直接医疗费用，并加强宣传和监测，以减少非正式支付。此外，应考虑影响分娩费用的因素，制定降低分娩费用的策略。
