Out-of-Pocket Expenditure and Catastrophic Health Spending on Maternity Care for Hospital Based Delivery Care in Empower
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Out-of-Pocket Expenditure and Catastrophic Health Spending on Maternity Care for Hospital Based Delivery Care in Empowered Action Group (EAG) States of India Shailendra Kumar 1
&
K. Anil Kumar 1
Accepted: 11 September 2020 # Springer Nature Switzerland AG 2020
Abstract Objectives In spite of efforts made by the Government of India through different programs and initiatives, the use of maternal healthcare is inadequate in India. India’s eight states are considered to be relatively socioeconomically backward and are referred to as the Empowered Action Group (EAG) states. This paper examines the variation in out-of-pocket expenditure (OOPE) in the utilization of maternal health services including antenatal care (ANC), delivery, and post-natal care (PNC) and quantifies the extent of catastrophic health spending (CHS) incurred and identify the factors influencing it in the EAG states of India. Methods Data from the National Sample Survey 71st Round was used for analysis. Catastrophic health spending (CHS) was measured as a share of household consumption expenditure on different cut-offs. Log-linear and logistic regressions were performed to examine the factors associated with maternity cost and CHS. Results The average spending on maternal cost was US$ 154 (ANC = US$ 35, delivery = US$ 82.5, and PNC=US$ 34). Fortyone percent of the households incurred catastrophic spending at the threshold level of 10%. Place of delivery, education, caste/ tribe, and economic quintile emerged as significant factors in explaining out-of-pocket expenditure on maternity care. Place of delivery and education are significant influences on CHS at a 10% cut-off. Conclusion Findings from this study assume importance in the context of reducing OPPE on maternity cost; the government needs to improve the financial cover for all types of cost incurred during the prenatal, delivery, and post-natal period under maternal health financing program and policies. Keywords Out-of-pocket expenditure . Catastrophic . Women . EAG states . India
Introduction Every woman should have access to all maternal care services during pregnancy and childbirth. It is preferred that all deliveries occur at a health facility or, if at home, are attended by skilled health professionals to ensure timely delivery care, proper management, and careful treatment. Various studies have indicated that countries that have improved their maternal healthcare services have successfully reduced maternal morbidity and mortality (Bartlett et al. 2005; Kilpatrick et al.
* Shailendra Kumar [email protected] K. Anil Kumar [email protected] 1
School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
2002; Rejoice and Ravishankar 2011). Globally, 303,000 women die each year as result of maternal complications and majority of these deaths occur in low- and middle-income countries; for instance, Nigeria and India account for onethird of maternal deaths worldwide (WHO 2015). In India, the maternal mortality ratio has declined from 212 in 2007– 2009 to 130 pe
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