印度剖宫产的自费支出和困境融资：来自 NFHS-5 的证据。

BACKGROUND: Though over three-fourths of all births receive medical attention in India, the rate of cesarean delivery (22%) is twice higher than the WHO recommended level. Cesarean deliveries entail high costs and may lead to financial catastrophe for households. This paper examines the out-of-pocket expenditure (OOPE) and distress financing of cesarean deliveries in India. METHODS: We used data from the latest round of the National Family Health Survey conducted during 2019-21. The survey covered 636,699 households, and 724,115 women in the age group 15-49 years. We have used 159,643 births those delivered three years preceding the survey for whom the question on cost was canvassed. Descriptive analysis, bivariate analysis, concentration index (CI), and concentration curve (CC) were used in the analysis. RESULT: Cesarean deliveries in India was estimated at 14.08%, in private health centres and 9.96% in public health centres. The prevalence of cesarean delivery increases with age, educational attainment, wealth quintile, BMI and high for those who had pregnancy complications, and previous birth as cesarean. The OOPE on cesarean births was US$133. It was US$498 in private health centres and US$99 in public health centres. The extent of distress financing of any cesarean delivery was 15.37%; 27% for those who delivered in private health centres compared to 16.61% for those who delivered in public health centres. The odds of financial distress arising due to OOPE on cesarean delivery increased with the increase of OOPE [AOR:10.00, 95% CI, 9.35-10.70]. Distress financing increased with birth order and was higher among those with low education and those who belonged to lower socioeconomic strata. CONCLUSION: High OOPE on a cesarean delivery leads to distress financing in India. Timely monitoring of pregnancy and providing comprehensive pregnancy care, improving the quality of primary health centres to conduct cesarean deliveries, and regulating private health centres may reduce the high OOPE and financial distress due to cesarean deliveries in India.

背景：尽管印度超过四分之三的分娩都接受了医疗护理，但剖宫产率（22%）却高出世界卫生组织建议水平的一倍。剖宫产分娩费用高昂，可能会使家庭陷入财务困境。本文研究了印度剖宫产分娩的自费支出（OOPE）和应急融资情况。

方法：我们使用了 2019-2021 年期间进行的最新一轮国家家庭健康调查的数据。该调查涵盖了 636699 户家庭和 724115 名 15-49 岁的女性。我们使用了调查前三年的 159643 次分娩数据，这些分娩都被问到了费用问题。我们采用了描述性分析、双变量分析、集中指数（CI）和集中曲线（CC）进行分析。

结果：印度的剖宫产率估计为 14.08%，其中私立医疗机构为 9.96%，公立医院为 14.08%。剖宫产率随年龄、教育程度、财富五分位数、BMI 以及妊娠并发症和前次剖宫产而增加。剖宫产分娩的自费支出为 133 美元。在私立医疗机构为 498 美元，在公立医院为 99 美元。任何剖宫产分娩的应急融资比例为 15.37%；在私立医疗机构分娩的比例为 27%，而在公立医院分娩的比例为 16.61%。剖宫产自费支出增加，导致财务困境的可能性也随之增加[比值比：10.00，95%置信区间：9.35-10.70]。应急融资随分娩次数增加而增加，在受教育程度较低和社会经济地位较低的人群中更为常见。

结论：印度剖宫产自费支出较高导致了应急融资。及时监测妊娠情况并提供全面的妊娠护理，改善初级保健中心的质量以开展剖宫产手术，以及规范私立医疗机构，可能会降低印度剖宫产自费支出和财务困境的发生率。