Maternity or catastrophe: A study of household expenditure on maternal health care in India

Mukherjee, Saradiya; Singh, Aditya; Chandra, Rakesh

doi:10.4236/health.2013.51015

Cited by 17 publications

(11 citation statements)

References 9 publications

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“…Among participants reporting informal payments in our study, none of the services were exempt from informal payments. Previously, multiple studies have reported on the OOPE at public health facilities to receive services during pregnancy, institutional delivery and infant care (Bonu, Bhushan, Rani, & Anderson, 2009; Issac, Chatterjee, Srivastava, & Bhattacharyya, 2016; Mondal, Mukhopadhyay, Mukhopadhyay, & Sinhababu, 2015; Mukherjee, Singh, & Chandra, 2013; Prinja et al, 2015; Shukla, Kumar, Agarwal, Singh, & Gupta, 2015; Tyagi, Pattabi, & Kaur, 2016). Diagnostics/investigations, followed by medications and consumables, accounted for the highest informal payments in our study.…”

Section: Discussionmentioning

confidence: 99%

Informal Payments for Maternal and Neonatal Health Services in Public Hospitals in Central India

Tripathi

John

Chatterjee

et al. 2020

Journal of Health Management

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Background: Informal payments are unauthorised ‘unregistered’ out-of-pocket payments, outside the official payment system, for purchase or service meant to be covered/provided by the healthcare system. This study attempts to measure and report the extent and magnitude of informal payments based on the entitlements in Janani-Shishu Suraksha Karyakram (JSSK) in the Indian context. Methods: A cross-sectional study using convenience sampling and a semi-structured interview schedule was conducted among 281 participants in 2016 in 26 JSSK-notifying health facilities from all five divisions of Chhattisgarh. Pregnant women and women who delivered in the previous year, and provided informed consent, were included. After reviewing various definitions, informal payment was operationally defined in the context of JSSK for India as ‘payments made in cash or kind, unregistered or non-reimbursed, made by/on behalf of the beneficiary or someone related thereof, for free and cashless entitlements in a JSSK-listed health facility, to an individual or institutional healthcare provider/staff who provides/arranges for provision of the service’. Results: Of 281 participants, 91.8 per cent reported informal payments across all JSSK entitlements categories. A relative majority of these payments was made at the district hospital (37%), ranging from ₹2 to ₹6,500 (US$0.03–101). Investigations incurred the greatest median amount of informal payments, at, ₹455 (US$7). Informal payments ranged between three and seven times higher than the JSSK price cap in Chhattisgarh. No significant association was found between participant characteristics and informal payments. Conclusion: Further research is required to understand the magnitude and motivation of informal payments made in programmes like JSSK.

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Section: Discussionmentioning

confidence: 99%

Informal Payments for Maternal and Neonatal Health Services in Public Hospitals in Central India

Tripathi

John

Chatterjee

et al. 2020

Journal of Health Management

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“…In contrast, a study in India used the local poverty line and found higher impoverishment due to maternal healthcare expenditure than the findings of our study. 32 Although Yangon Region is the most developed region in Myanmar, a lot of non-poor households face impoverishment and deep poverty which could be explained by high maternal healthcare payments without a compensation scheme. 10 20 Two studies from India using data from 2004 and 2015 found that the poverty headcount ratio for maternal healthcare expenditures declined after introducing free services for delivery care in 2015.…”

Section: Discussionmentioning

confidence: 99%

“…10 20 Two studies from India using data from 2004 and 2015 found that the poverty headcount ratio for maternal healthcare expenditures declined after introducing free services for delivery care in 2015. 32 33 …”

Section: Discussionmentioning

confidence: 99%

“…11 Higher incidences of catastrophic expenditure due to OOP payments were reported in India and Ethiopia because poorer women were included and all ANC, delivery and postnatal care services were considered. 32 34 Prior studies from Africa and Bangladesh concluded that more than one-third of women faced catastrophic expenditure due to OOP payments for emergency obstetric care because they were poor and were required to pay for drugs. 35–37…”

Section: Discussionmentioning

confidence: 99%

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Impoverishment and catastrophic expenditures due to out-of-pocket payments for antenatal and delivery care in Yangon Region, Myanmar: a cross-sectional study

et al. 2018

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Objectives(1) To assess the levels of impoverishment and catastrophic expenditure due to out-of-pocket (OOP) payments for antenatal care (ANC) and delivery care in Yangon Region, Myanmar; and (2) to explore the determinants of impoverishment and catastrophic expenditure.Design, setting and participantsA community-based cross-sectional survey among women giving birth within the past 12 months in Yangon, Myanmar, was conducted during October to November 2016 using three-stage cluster sampling procedure.Outcome measuresPoverty headcount ratio, normalised poverty gap and catastrophic expenditure incidence due to OOP payments in the utilisation of ANC and delivery care as well as the determinants of impoverishment and catastrophic expenditure.ResultsOf 759 women, OOP payments were made by 75% of the women for ANC and 99.6% for delivery care. The poverty headcount ratios after payments increased to 4.3% among women using the ANC services, to 1.3% among those using delivery care and to 6.1% among those using both ANC and delivery care. The incidences of catastrophic expenditure after payments were found to be 12% for ANC, 9.1% for delivery care and 20.9% for both ANC and delivery care. The determinants of impoverishment and catastrophic expenditure were women’s occupation, number of household members, number of ANC visits and utilisation of skilled health personnel and health facilities. The associations of the outcomes with these variables bear both negative and positive signs.ConclusionsOOP payments for all ANC and delivery care services are a challenge to women, as one of fifteen women become impoverished and a further one-fifth incur catastrophic expenditures after visiting facilities that offer these services.

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“…In this regard, the finding that the richer, educated, and regularly salaried women were less likely to incur catastrophic maternity expenditure is similar to the findings of previous studies conducted in India and elsewhere. 9 , 12 It is argued that richer and educated women are often more aware about the functioning of the health system and government health schemes through their greater exposure to the mass media, and know their healthcare rights as a mother which helps them avoid making any informal payment to avail services in public health facilities. The findings revealed that the non-JSY women were several times more likely to experience catastrophic maternal expenditure compared to the JSY beneficiaries.…”

Section: Discussionmentioning

confidence: 99%

Has the Janani Suraksha Yojana (A Conditional Maternity Benefit Transfer Scheme) Succeeded in Reducing the Economic Burden of Maternity in Rural India? Evidence from the Varanasi District of Uttar Pradesh

Mukherjee¹,

Singh

2018

Journal of Public Health Research

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BackgroundOne of the constraints in the utilisation of maternal healthcare in India is the out-of-pocket expenditure. To improve the utilisation and to reduce the out-of-pocket expenditure, India launched a cash incentive scheme, Janani Suraksha Yojana (JSY), which provides monetary incentive to the mothers delivering in public facility. However, no study has yet examined the extent to which the JSY payments reduce the maternal healthcare induced catastrophic out-of-pocket expenditure burden of the households. This paper therefore attempts to examine the extent to which the JSY reduces the catastrophic expenditure estimate household expenditure on maternity, i.e., all direct and indirect expenditure.Materials and methodsThe study used data on 396 mothers collected through a primary survey conducted in the rural areas of the Varanasi district of Uttar Pradesh state in 2013-2014. The degree and variation in the catastrophic impact of households’ maternity spending was computed as share of out-of-pocket payment in total household income in relation to specific thresholds, across socioeconomic categories. Logistic regression was used to understand the determinants of catastrophic expenditure and whether the JSY has any role in influencing the expenditure pattern.ResultsResults revealed that the JSY beneficiaries on an average spent about 8.3% of their Annual Household Consumption Expenditure on maternity care. The JSY reimbursement could reduce this share only by 2.1%. The study found that the expenditure on antenatal and postnatal care made up a significant part of the direct medical expenditure on maternity among the JSY beneficiaries. The indirect or non-medical expenditure was about four times higher than the direct expenditure on maternity services. The out-of-pocket expenditure across income quintiles was found to be regressive i.e. the poor paid a greater proportion of their income towards maternity care than the rich. Results also showed that the JSY reimbursement helped only about 8% households to escape from suffering catastrophic burden due to maternity payments.ConclusionsIt can be concluded that the JSY appeared to have achieved only a limited success in reducing the economic burden due to maternity. To reduce the catastrophic burden, policy makers should consider increasing the JSY reimbursement to cover not only antenatal and postnatal services but also non-medical expenditure due to maternity. The government should also take appropriate measures to curb non-medical or indirect expenditure in public health facilities.Significance for public healthImproving the well-being of mothers is an important public health goal for India. For improving maternal health, it is necessary that mothers utilize maternity services. However, maternity often becomes an economic burden, especially for disadvantaged and poorer groups of the society. To encourage mothers to utilize services, India launched a conditional maternity benefit transfer scheme back in 2005. This study explored whether the scheme has been able to hel...

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Maternity or catastrophe: A study of household expenditure on maternal health care in India

Abstract:
Using data from 60^th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal… Show more

Cited by 17 publications

References 9 publications

Informal Payments for Maternal and Neonatal Health Services in Public Hospitals in Central India

Informal Payments for Maternal and Neonatal Health Services in Public Hospitals in Central India

Impoverishment and catastrophic expenditures due to out-of-pocket payments for antenatal and delivery care in Yangon Region, Myanmar: a cross-sectional study

Has the Janani Suraksha Yojana (A Conditional Maternity Benefit Transfer Scheme) Succeeded in Reducing the Economic Burden of Maternity in Rural India? Evidence from the Varanasi District of Uttar Pradesh

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Maternity or catastrophe: A study of household expenditure on maternal health care in India

Abstract: Using data from 60th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal… Show more

Cited by 17 publications

References 9 publications

Informal Payments for Maternal and Neonatal Health Services in Public Hospitals in Central India

Informal Payments for Maternal and Neonatal Health Services in Public Hospitals in Central India

Impoverishment and catastrophic expenditures due to out-of-pocket payments for antenatal and delivery care in Yangon Region, Myanmar: a cross-sectional study

Has the Janani Suraksha Yojana (A Conditional Maternity Benefit Transfer Scheme) Succeeded in Reducing the Economic Burden of Maternity in Rural India? Evidence from the Varanasi District of Uttar Pradesh

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Product

Resources

About

Abstract:
Using data from 60^th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal… Show more