Background: Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. Factors like education, economic status and out of pocket (OOP) expenditure can affect utilization of maternal health services. Hence this study aims to assess the utilization pattern of maternal health care and the out of pocket expenditure for delivery services in a public maternity hospital. Methods: A cross sectional study was conducted using primary data from women who delivered in public maternity hospital, Mangaluru during January -February 2018. Study respondents were interviewed using pre-tested, interview schedule. The data was analysed using SPSS 20.0 version. Results: 78.3% of the respondents visited the health care provider during first trimester of pregnancy. 97.3% of the mothers attended ≥4 antenatal visits. The time of the first ANC visit, consumption of Iron folic acid (IFA) tablets, choice of provider for ANC are significantly associated with caste, education of the respondents and their husbands. The mean expenditure for delivery care, including indirect expenditure was ₹2875. Expenditure during delivery was significantly associated with respondent's education and type of delivery. Conclusions: Socio demographic characteristics like caste and education did seem to have an effect on the utilization of ANC especially consumption of IFA. Education and communication campaigns may aid to improve this. Good implementation of government schemes can help to reduce the direct OOP expenditure for delivery care. The indirect cost associated with maternity care may still be a burden for poor families.

The public health spending in India has been hovering around 1% of gross domestic product (GDP), and it contributes only 28% of total health expenditure. Hence, out-of-pocket (OOP) payments continue to be the dominant source of health care financing in India. However, for providing protection from the economic effects of health shocks, last few years have seen a plethora of central and state government-sponsored private health insurance schemes for the deprived groups, particularly those working in the unorganized sector. The latest is the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY), launched by the Government of Maharashtra in 2012. This study is an attempt to assess the extent to which RGJAY protects the families from making OOP expenditure while availing the tertiary care from the RGJAY accredited facilities. Both primary and secondary data were utilized for this study. Despite being enrolled in RGJAY, more than three fifths (63%) of the beneficiaries still incurred OOP payments for services when admitted in the hospital, and more worryingly, it was found that a significantly higher proportion of persons from Below Poverty Line (BPL) families (88.23%) reported paying for diagnostics, medications, or consumables. Furthermore, our study found that about a third of the beneficiaries experienced financial catastrophe if indirect expenditure is taken into consideration. This also implies that for the poor, ill-health has further deepened the existing poverty.

PurposeThe rapidly increasing burden of cancer in India has profound impacts on health care costs for patients and their families. High out-of-pocket (OOP) expenditure, lack of insurance, and low government expenditure create a vicious cycle, leading to household impoverishment. Complex cancer surgery is now increasingly important for emerging countries; however, little is understood about the macro- and microeconomics of these procedures. After the Lancet Oncology Commission on Global Cancer Surgery, we evaluated the OOP expenditure for patients undergoing pancreatico-duodenectomy (PD) at a government tertiary cancer center in India.MethodsProspective data from 98 patients who underwent PD between January 2014 and June 2015 were collected and analyzed. The time frame for consideration of expenses, including all preoperative investigations, was from the first hospital visit to the day of discharge. Catastrophic expenditure was calculated by assessing the percentage of households in which OOP health payments exceeded 10% of the total household income.ResultsThe mean expenditure for PD by patients was Rs.295,679.57 (US$74,420, purchasing power parity corrected). This amount was significantly higher among those admitted to a private ward and those with complications. Only 29.6% of the patients had insurance coverage. A total of 76.5% of the sample incurred catastrophic expenditure, and 38% of those with insurance underwent financial catastrophe compared with 93% of those without insurance. The percentage of patients facing catastrophic impact was highest among those in semiprivate wards, at 86.7%, followed by those in public and private wards.ConclusionThe cost of PD is high and is often unaffordable for a majority of India’s population. A review of insurance coverage policies for better coverage must be considered.