DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20151126

Out of pocket expenditure on utilization of ante-natal and delivery care services in India: analysis based on NSSO 60th round

Saraswati Kerketta

Abstract


Background: Maternal mortality is a major concern in India; it can be reduced by providing reproductive health care services to the pregnant women. Out of pocket expenditure is a major barrier to the mothers in access to the maternal care services in India.

Methods: Data has been extracted from NSSO 60th round. Univariate and multivariate analysis has been carried out to examine the pattern and factors affecting out of pocket expenditure on ante natal and delivery care services in India.

Results: There are differentials between public and private health facilities in terms of out of pocket expenditure on maternal care services in India. The Logit Model explains that urban mothers are 1.6 times (OR=1.652) and 3.2 times (OR=3.273) significantly more likely of OoP expenditure on ANC and delivery Care. Among the social groups, a big difference can be seen in terms of expenditure on delivery care services. As women’s educational level increases, the likelihood of out of pocket expenditure on delivery care services also increases. Women in higher age groups have more chances of out of pocket expenditure in receiving ante natal and delivery care with reference category (age <= 19). Mothers with third quintile of MPCE are 6.9 times (OR= 6.983) and 11.5 times (OR= 11.547) more likely of OoP expenditure on ANC and deliver care than reference category (first quintile).

Conclusions: The out of pocket expenditure is the main barrier in access to the health care services to the pregnant women. The government must ensure a free of cost institutional delivery especially to the poor mothers so that the maternal mortality can be reduced.

Keywords


Maternal Mortality, ANC, Delivery Care, Out of Pocket Expenditure, Socio-economic factors

Full Text:

PDF

References


Rama RS, Caleb L, Khan ME, Townsend JW. Safer maternal health in rural Uttar Pradesh: do primary health services contribute? Health Policy Plan. 2001;16(3):256-63.

Borghi J, Ensor T, Somanathan A, Lissner C, Mills A. Mobilising financial resources for maternal health. Lancet. 2006;368(9545):1457-65.

Martines J, Paul VK, Bhutta ZA, Koblinsky M, Soucat A, Walker N, et al. Neonatal survival: a call for action. Lancet. 2005;365(9465):1189-97.

Bulatao RA, Ross JA. Which health services reduce maternal mortality? Evidence from ratings of maternal health services. Trop Med Int Health. 2003;8(8):710-21.

Su TT, Kouyate B, Flessa S. Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bull World Health Organ. 2006;84(1):21-7.

Frenk J. Bridging the divide: global lessons from evidence-based health policy in Mexico. Lancet. 2006;368(9539):954-61.

Musgrove P, Zeramdini R, Carrin G. Basic patterns in national health expenditure. Bull World Health Organ. 2002;80(2):134-42.

Van DE, O’Donnell O, Rannan ER, Somanathan A, Adhikari S, Garg C, et al. Catastrophic payments for health care in Asia. Health Economics. 2007:16(11):1159-84.

Devadasan N, Criel B, Van DW, Ranson K, Vander SP: Indian community health insurance schemes provide partial protection against catastrophic health expenditure. BMC Health Serv Res. 2007;7:43.

Ellis RP, Alam M, Gupta I. Health Insurance in India: Prognosis and Prospectus. Economic and Political Weekly. 2000;35(4):207-17.

Freeman DHJr., Gesler WM, Mieras BJ. A categorical data analysis of contacts with the family health clinic, Calabar, Nigeria. Social Science and Medicine. 1983;17(9):571-8.

Sauerborn RA, Nougtara, Diesfeld HJ. Low utilisation of community health workers: Results from a household interview survey in Burkina Faso. Social Science and Medicine. 1989;29(10):1163-74.

Yoder RA. Are people willing and able to pay for health services? Social Science and Medicine. 1989;29(1):35-42.

Wagstaff A. Poverty and health sector inequalities. Bull World Health Organ. 2002;80(2):97-105.

Van DE, O’Donnell O, RERP, Somanathan A, Adhikari SR, Garg CC, Harbianto D, Herrin AN, Huq MN, Ibragimova S. Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. Lancet. 2006;368(9544):1357-64.

Whitehead M, Dahlgren G, Evans T. Equity and health sector reforms: can low-income countries escape the medical poverty trap? Lancet. 2001;358(9284):833-6.

Whitehead M, Diderichsen F. Social capital and health: tip-toeing through the minefield of evidence. Lancet. 2001;358(9277):165-6.

Sanjay KM, Akanksha S. Out-of-pocket expenditure on institutional delivery in India. Health Policy and Planning. 2013;28:247-62.

Limwattananon S, Tangcharoensathien V, Prakongsai P. Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand. Bulletin of the World Health Organization. 2007;85:600-6.

Kanjilal B, Mukherjee M, Singh S, Mondal S, Barman D, Mandal A. Health, equity and poverty exploring the links in West Bengal. FHS Working Paper, 2007.

Yardim M, Cilingiroglu N, Yardim N. Catastrophic health expenditure and impoverishment in Turkey. Health Policy. 2009;94(1):26-33.

World Health Organization. Health services utilization and out-of-pocket expenditure at public and private facilities in low-income countries. Geneva, Switzerland, 2010.