Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
Department of Economics, Faculty of Social Sciences and Humanities, Rajarata University of Sri Lanka, Mihintale, Sri Lanka.
Glob Health Sci Pract. 2023 Oct 30;11(5). doi: 10.9745/GHSP-D-22-00410.
Global evidence suggests that high out-of-pocket (OOP) expenditure negatively affects health service utilization and creates an economic burden on households during pregnancy. This study aimed to estimate the magnitude and associated factors of OOP expenditure for antenatal care (ANC) in a rural Sri Lankan setting by following up with a large pregnancy cohort (The Rajarata Pregnancy Cohort [RaPCo]) in Anuradhapura District, Sri Lanka.
Data were collected from July 2019 to May 2020. An interviewer-administered questionnaire was used to collect socioeconomic data and OOP expenditures in the first trimester. Self-administered questionnaires were used monthly to collect OOP expenditures in the second and third trimesters. In-depth financial information of 1,558 pregnant women was analyzed using descriptive statistics, nonparametric statistics, and a multiple linear regression model.
The majority of participants used both government and private health facilities for ANC. The mean (standard deviation [SD]) OOP expenditure per ANC visit was US$4.18 (US$4.19), and the mean (SD) OOP expenditure for total ANC was US$57.74 (US$80.96). Pregnant women who used only free government health services also spent 28% and 14% of OOP expenditure on medicines and laboratory investigations. Household income (<.001), household expenditure (<.1), used health care mode (<.05), maternal morbidities (<.05), and the number of previous pregnancies (<.1) were the statistically significant independent predictors of OOP expenditure. OOP expenditure per visit for ANC equals half of the daily household expenditure.
Despite having freely available government health facilities, most pregnant women tend to use both government and private health facilities and incur higher OOP expenditure. Free government health care users also incur a direct medical OOP expenditure for medicines and laboratory investigations. Monthly household income, expenditure, used health care mode, maternal morbidities, and the number of previous pregnancies are independent predictors of OOP expenditure.
全球证据表明，高自付（OOP）支出会对卫生服务的利用产生负面影响，并在妊娠期间给家庭带来经济负担。本研究旨在通过跟踪斯里兰卡阿努拉达普拉区的一项大型妊娠队列（拉贾拉特卡妊娠队列[RaPCo]），评估农村斯里兰卡产前保健（ANC）的 OOP 支出规模及其相关因素。
数据收集于 2019 年 7 月至 2020 年 5 月期间进行。采用访谈者管理的问卷收集社会经济数据和孕早期的 OOP 支出。采用自我管理的问卷每月收集第二和第三孕期的 OOP 支出。对 1558 名孕妇的深入财务信息进行了描述性统计、非参数统计和多元线性回归模型分析。
大多数参与者在 ANC 期间既使用政府卫生设施又使用私人卫生设施。每次 ANC 就诊的平均（标准差[SD]）OOP 支出为 4.18 美元（4.19 美元），总 ANC 的平均（SD）OOP 支出为 57.74 美元（80.96 美元）。仅使用免费政府卫生服务的孕妇在药品和实验室检查上的 OOP 支出也分别占 28%和 14%。家庭收入（<.001）、家庭支出（<.1）、使用的医疗模式（<.05）、产妇合并症（<.05）和既往妊娠次数（<.1）是 OOP 支出的独立显著预测因素。每次 ANC 就诊的 OOP 支出相当于家庭日支出的一半。
尽管有免费的政府卫生设施，但大多数孕妇倾向于同时使用政府和私人卫生设施，并产生更高的 OOP 支出。免费政府医疗保健用户还会因药品和实验室检查而产生直接的医疗 OOP 支出。每月家庭收入、支出、使用的医疗模式、产妇合并症和既往妊娠次数是 OOP 支出的独立预测因素。
