Out-of-pocket expenditure and correlates of caesarean births in public and private health centres in India

Mohanty, Sanjay K.; Panda, Basant Kumar; Khan, Pijush Kanti; Behera, Priyamadhaba

doi:10.1016/j.socscimed.2019.01.048

Cited by 27 publications

(29 citation statements)

References 53 publications

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“…The state variation in OOPE on institutional delivery was large-higher in economically better off states and lower in the poorer states of India. This finding is consistent with literature [45,58,61]. Second, about two-fifths of the mothers utilized their savings, onefifth of them resorted to only selling and borrowing, while one in seven mothers borrowed/sold assets in addition to using their savings to meet the OOPE on institutional delivery.…”

Section: Discussionsupporting

confidence: 89%

“…The proportion of mothers who met their expenses on institutional delivery by borrowing or selling assets was highest in the states of Telangana (29%) and Bihar (28.8%) followed by Tamil Nadu (26%) and Odisha (23.4%). About half of the women in Telangana had caesarean delivery and the cost of a caesarean delivery was at least three times higher than that of vaginal delivery [58]. Those who met the expenses on institutional delivery through combined means of saving, selling and borrowing was highest in Manipur (17.4%) followed by Uttar Pradesh (10.2%).…”

Section: Discussionmentioning

confidence: 99%

“…The unit data was cleaned for reported errors on OOPE before the analysis. The details and procedure of data cleaning is available elsewhere [58].…”

Section: Methodsmentioning

confidence: 99%

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Out-of-pocket expenditure and distress financing on institutional delivery in India

Mishra

Mohanty

2019

Int J Equity Health

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Background: Despite large investment in central and state sponsored schemes for maternal care, out-of-pocket expenditure (OOPE) and catastrophic health spending (CHS) on institutional delivery remain high over time, across states and across socioeconomic groups. Though many studies have examined the OOPE and CHS, few studies have examined the nature and extent of distress financing on institutional delivery in India. Data: Data from the fourth round of National Family Health Survey (NFHS 4), 2015-16 was used for the analysis. Distress financing was defined as borrowing money or selling assets to meet the OOPE on delivery care. Composite variables, descriptive analyses, concentration index (CI), concentration curve (CC) and predicted probability were used to estimate the extent of distress financing for institutional delivery in India. Results: The OOPE on institutional delivery has strong economic and educational gradient. One in four mothers resorted to borrowing or selling to meet the OOPE on institutional delivery. The extent of distress financing on institutional delivery was high in poorer state of Bihar and Odisha and in the state of Telangana that had highest prevalence of caesarean delivery. Savings was more prevalent among mothers compared to those who met the OOPE by borrowing/selling of assets. Finding are robust across the states of India. The predicted probability of incurring distress financing was 0.31 among mothers belonging to the poorest wealth quintile compared to 0.09 in the richest quintile, and 0.40 for those who incurred OOPE of more than INR 20,000. The probability of incurring distress financing was higher for mothers who had caesarean birth, delivered in private health centers and incurred high OOPE on institutional delivery. Conclusion: Distress financing on institutional delivery was higher among the less educated, poor and in private health centers. Increasing use of public health centers, reducing caesarean births, improving the availability of medicine and diagnostic services can reduce the extent of distress financing in India.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Out-of-pocket expenditure and distress financing on institutional delivery in India

Mishra

Mohanty

2019

Int J Equity Health

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“…The unit data was cleaned for factual errors on OOP payment before the analysis. The details and procedure for data cleaning are available elsewhere [36].…”

Section: Methodsmentioning

confidence: 99%

“…Delivery from public health centres has increased from 18% in 2005-06 to 52.1% by 2015-16 [30,35]. Despite the increase in coverage of services, the out-of-pocket (OOP) expenditure and catastrophic health spending (CHS) on delivery care remained high [36][37][38]. Studies suggest that inequality in health care services has widened across state, rural and urban area and among wealth quintile [39][40].…”

Section: Introductionmentioning

confidence: 99%

Understanding equity of institutional delivery in public health centre in India: An assessment using Benefit Incidence Analysis

Mohanty

Mishra

et al. 2020

Preprint

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Background: The National Health Mission (NHM), the largest ever publicly funded health programme worldwide used over half of the national health budget in India and primarily targeted to improve maternal and child health in the country. Though increased public health investment in India has improved the health care utilization and health outcomes across geographies and socio-economic groups, little is known on equity aspect of such large scale investment. In this context, this paper examines the utilisation pattern of delivery care and equity aspect of public investment in India.Methods: Data from the recent round of National Family Health Survey (NFHS 4) conducted during 2015-16 used in the analyses. A total of 148,645 last birth delivered in an institution in a reference period of five years has been used in the analyses. The out-of-pocket (OOP) payment on delivery care is the dependent variable. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) used in the analysis.Results: Utilization of natal care from public health centres in India is pro-poor and have a strong economic gradient. However, about 28% mothers in richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. The median OOP payments for institutional delivery from public health centre was ₹1200 for mothers belonging to the poorest wealth quintile compared to ₹2000 for mothers belonging to richest wealth quintile. Benefit incidence analyses suggests that about 17.4 % of subsidies were used among poorest, 19.3% among richest quintile and 21.9% in the middle quintile. The concentration index of institutional delivery from public health centres was -0.161 [95% Confidence Interval: -0.158, -0.165] compared to 0.296 [95% Confidence Interval: 0.289, 0.303] from private health centres.Conclusion: Utilisation of natal care services from public health centres in India is pro-poor. However, benefit-incidence analyses suggest that the use of subsidy is relatively higher among wealthier and better off mothers in India.

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Institutional Delivery and Cesarean Births in India

Guilmoto

2023

Demographic Transformation and Socio-Economic Development

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Out-of-pocket expenditure and correlates of caesarean births in public and private health centres in India

Cited by 27 publications

References 53 publications

Out-of-pocket expenditure and distress financing on institutional delivery in India

Out-of-pocket expenditure and distress financing on institutional delivery in India

Understanding equity of institutional delivery in public health centre in India: An assessment using Benefit Incidence Analysis

Institutional Delivery and Cesarean Births in India

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