Health care expenditure for delivery care between maternity waiting home users and nonusers in<scp>E</scp>thiopia

Getachew, Biniam; Liabsuetrakul, Tippawan

doi:10.1002/hpm.2782

Cited by 11 publications

(22 citation statements)

References 20 publications

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“…Women in the age group of 19 to 40 years have higher incidence of hospitalization. This is consistent with other studies which show that women in the reproductive age group have higher rates of hospitalizations and incur higher health expenditures (49,50).…”

Section: Discussionsupporting

confidence: 93%

Effect of Health Insurance Program for the Poor on Out-Of-Pocket Inpatient Care Cost in India

Sriram¹,

Khan²

2020

Preprint

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Background In India, Out-of-pocket expenses accounts for about 62.6% of total health expenditure - one of the highest in the world. Lack of health insurance coverage and inadequate coverage are important reasons for high out-of-pocket health expenditures. There are many Public Health Insurance Programs offered by the Government that cover the cost of hospitalization for the people below poverty line (BPL), but their coverage is still not complete. The objective of this research is to examine the effect of Public Health Insurance Programs for the Poor on hospitalizations and inpatient Out-of-Pocket costs. Methods Data from the recent national survey by the National Sample Survey Organization, Social Consumption in Health 2014 are used. Propensity score matching was used to identify comparable non-enrolled individuals for individuals enrolled in health insurance programs. Binary logistic regression model, Tobit model, and a Two-part model were used to study the effects of enrolment under Public Health Insurance Programs for the Poor on the incidence of hospitalizations. duration of hospitalization, and Out-of-Pocket payments for inpatient care respectively.Results There were 64,270 BPL people in the sample. Individuals enrolled in poor people health insurance program have 1.21 higher odds of incidence of hospitalization compared to matched poor individuals not having health insurance coverage. Enrollment under the poor people health insurance program did not have any effect on duration of hospitalization and inpatient Out-of-Pocket health expenditures. Logistic regression model showed that chronic illness, household size, and age of the individual had significant effects on hospitalization incidence. Tobit model results showed that individuals who had chronic illnesses and belonging to other backward social group had significant effects on duration of hospitalization. Two-part regression model showed that days of hospital stay, graduate level education, specific age groups, using a private hospital for treatment, admission in a paying ward, and having some specific ailments had significant positive effect on out-of-pocket costs. Conclusions Enrolment in the public health insurance programs for the poor increased the utilization of inpatient health care facilities. Health insurance coverage must be expanded to cover outpatient services, and the coverage must not be limited by the number of family members.

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Section: Discussionsupporting

confidence: 93%

Effect of Health Insurance Program for the Poor on Out-Of-Pocket Inpatient Care Cost in India

Sriram¹,

Khan²

2020

Preprint

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“…Then, 27 articles with a sample size of 331,537 participants were included to assess determinants of the burden of household Out-Of-Pocket healthcare expenditures. Of these, six articles were conducted at the national level [ 13 , 33 – 37 ]. The remaining 21 articles were conducted in different parts of Ethiopia: i.e., six articles were conducted in the south regional state [ 14 , 33 – 37 ], five articles in Amhara regional state [ 38 – 42 ], five articles in Addis Ababa city [ 43 – 47 ], three articles in Oromiya regional state [ 48 – 50 ], one article in Bensangual-Gumuz regional state [ 51 ], and one article in a combination of Afar and Oromiya regional states [ 52 ].…”

Section: Resultsmentioning

confidence: 99%

The burden of household out-of-pocket healthcare expenditures in Ethiopia: a systematic review and meta-analysis

Borde

Kabthymer

Shaka

et al. 2022

Int J Equity Health

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Background In Ethiopia, household Out-Of-Pocket healthcare expenditure accounts for one-third of total healthcare expenditure, is one of the highest in the world, and still creates barriers and difficulties for households to healthcare access and may delay or forgo needed healthcare use. Despite the presence of a few highly dispersed and inconsistent studies, no comprehensive study was conducted. Therefore, in this systematic review and meta-analysis, we aimed at estimating the pooled estimates of the burden of household Out-Of-Pocket healthcare expenditures among Ethiopian households and identifying its determinants. Methods We systematically searched articles from PubMed / Medline and Google scholar databases and direct Google search engine without restriction on publication period. Cross-sectional and cohort articles and grey literature published in English were included. Data were extracted using Microsoft Excel. Two reviewers screened the titles, reviewed the articles for inclusion, extracted the data, and conducted a quality assessment. The third reviewer commented on the review. Articles with no abstracts or full texts, editorials, and qualitative in design were excluded. To assess quality, Joanna Briggs Critical Appraisal Tools was used. A Forest plot was used to present summary information on each article and pooled common effects. Potential heterogeneity was checked using Cochrane’s Q test and I-squared statistic. We checked publication bias using a Funnel plot. Moreover, subgroup and sensitivity analyses were performed. Meta-analysis was used for the pooled estimates using RevMan statistical software Version 5.4.1. Results In this review, a total of 27 primary articles were included (with a total sample size of 331,537 participants). Because of the presence of heterogeneity, we employed a random-effects model; therefore, the pooled burden household Out-Of-Pocket / catastrophic healthcare expenditure in Ethiopia was strongly positively associated with household economic status. The odds of facing Out-Of-Pocket / catastrophic healthcare expenditures among the poorest quintile was about three times that of the richest (AOR = 3.09, 95% CI: 1.63, 5.86) p-value < 0.001. In addition, on pooled analysis, the mean direct Out-Of-Pocket healthcare expenditures were $32 per month (95%CI: $11, $52) (SD = $45), and the mean indirect Out-of-Pocket healthcare expenditures were $15 per month (95%CI: $3, $28) (SD = $17). The mean catastrophic healthcare expenditure at 10% of threshold was also disproportionately higher: 40% (95%CI: 28, 52%) (SD = 20%). Moreover, the common coping mechanisms were a sale of household assets, support from family, or loan: 40% (95%CI: 28, 52%) (SD = 20%). Conclusion Our study revealed the evidence of inequity in financial hardship that the burden of household Out-Of-Pocket / catastrophic healthcare expenditures gap persists among Ethiopian households that is unfair and unjust. To reduce the detected disparities in seeking healthcare among Ethiopian households, national healthcare priorities should target poor households. This calls for the Ministry of Health to improve the challenges and their impact on equity and design better prepayment policies and strengthen financial protection strategies to protect more vulnerable Ethiopian households. Protocol registration The details of this protocol have been registered on the PROSPERO database with reference number ID: CRD42021255977.

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“…Additionally, the authors found major differences between MWH users and non-users, whereas our analysis showed very few. 24 They concluded that MWH users have significantly higher OOP costs than nonusers, but we believe this difference emerged from different sampling frames and methodology. 24 Overall, our findings suggest that, for women living most remotely who deliver at rural health facilities in Zambia, using a MWH does not cost significantly more than delivering at a rural health facility without using a MWH when considering key categories of common delivery-related expenses.…”

Section: Discussionmentioning

confidence: 93%

“…Yet, there is little empirical evidence on whether expenditure differences exist between those who use MWHs and those who do not (referred throughout the rest of this paper as 'users' and 'non-users' respectively). 24 Within a broader impact evaluation of the MHA, we analyzed self-reported OOP expenditure for women living remotely who recently delivered at a health facility. We compared OOP spending of women who stayed at MWHs and those who did not for their most recent delivery to better understand how MWH use factors into OOP expenditure for facility delivery among socioeconomically disadvantaged women in rural Zambia.…”

mentioning

confidence: 99%

Out-of-Pocket Expenditures for Delivery for Maternity Waiting Home Users and Non-users in Rural Zambia

Fontanet

Kaiser

Fong

et al. 2021

Int J Health Policy Manag

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Background: Utilizing maternity waiting homes (MWHs) is a strategy to improve access to skilled obstetric care in rural Zambia. However, out-of-pocket (OOP) expenses remain a barrier for many women. We assessed delivery-related expenditure for women who used MWHs and those who did not who delivered at a rural health facility. Methods: During the endline of an impact evaluation for an MWH intervention, household surveys (n = 826) were conducted with women who delivered a baby in the previous 13 months at a rural health facility and lived >10 km from a health facility in seven districts of rural Zambia. We captured the amount women reported spending on delivery. We compared OOP spending between women who used MWHs and those who did not. Amounts were converted from Zambian kwacha (ZMW) to US dollar (USD). Results: After controlling for confounders, there was no significant difference in delivery-related expenditure between women who used MWHs (US$40.01) and those who did not (US$36.66) (P=.06). Both groups reported baby clothes as the largest expenditure. MWH users reported spending slightly more on accommodation compared to those did not use MWHs, but this difference represents only a fraction of total costs associated with delivery. Conclusion: Findings suggest that for women coming from far away, utilizing MWHs while awaiting delivery is not costlier overall than for women who deliver at a health facility but do not utilize a MWH.

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Health care expenditure for delivery care between maternity waiting home users and nonusers inEthiopia

Cited by 11 publications

References 20 publications

Effect of Health Insurance Program for the Poor on Out-Of-Pocket Inpatient Care Cost in India

Effect of Health Insurance Program for the Poor on Out-Of-Pocket Inpatient Care Cost in India

The burden of household out-of-pocket healthcare expenditures in Ethiopia: a systematic review and meta-analysis

Out-of-Pocket Expenditures for Delivery for Maternity Waiting Home Users and Non-users in Rural Zambia

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