Predictors of ‘Out-of-Pocket Expenditure’ on Routine Immunization of Under-Five Children: A Regression Analysis

Abstract

Introduction: 'Out-of-pocket expenditure' (OOPE) is the expenditures at the point of receiving health care directly by households which affects the economic stability of the household. When the expenditure on immunization of under-five children results in OOPE, it affects the motivation of parents for vaccination inversely. Aim: This study was planned to evaluate the out-of-pocket expenditure and to assess predictors of OOPE on routine immunization practices. Settings and design: This was a cross-sectional community-based study conducted from May to August 2019 at one of the immunization sites at primary health centers under a tertiary care institute of southern Rajasthan. Material and methods: At the selected health facility, randomly 75% of beneficiaries of routine immunization were enrolled for the study. Data were collected using a pre-designed, pre-tested semistructured questionnaire about direct and indirect expenses during the process of immunization incurred by the parents of the vaccinee by interview technique. Results: In the study, 72.36% were infants, and 56.10% had first birth order. Mother accompanied nearly half of the vaccinee (49.6%) to the vaccination centre and the most used mode of transportation was the personal vehicle (63%). Mean loss of wages among parents/caretakers was 0.58 (±0.66) USD (median = 0.69; interquartile range (IQR) = 0.69; 95% confidence interval (CI) = 0.42-0.73) while average cost of transportation worn was 0.16 (±0.20) USD (median = 0.07; IQR = 0.21; 95% CI = 0.12-0.19) and mean duration of travelling to reach health facility was 11.87 (±7.53) minutes (median = 10; IQR = 10; 95% CI = 10.53-13.20). Vaccination at the centre was free of cost (zero USD) and no cost was incurred for drugs or registration. Average OPPE was 0.74 (±0.97) USD (median = 0.35; IQR = 0.62; 95% CI = 0.56-0.91) and regression analysis predicted significant contributors as age of vaccinee (p = 0.00; OR = 0.11; 95% CI = 0.04-0.34), religion (p = 0.04; OR = 0.34; 95% CI = 0.12-0.97) area of residence (p = 0.00; OR = 6.77; 95% CI = 2.37-19.32), birth order of vaccinee (p = 0.02; OR = 0.3; 95% CI = 0.11-0.85), longer waiting time (p = 0.03; OR = 0.16; 95% CI = 0.03-0.85), travelling time (p = 0.00; OR = 3.47; 95% CI = 1.49-8.09) and long distances (p = 0.00; OR = 10.40; 95% CI = 2.56-42.03) travelled to reach vaccination centre. Conclusion: The hidden cost of vaccination in the form of loss of wages and time, travel cost due to stretched distance traveled by family members to accompany vaccinee to immunization facility is experienced as OOPE by the families and could be one of the impediments in vaccination coverage. Amendments in the existing policies are required to reduce this invisible cost of vaccination.

Out-of-pocket expenditure and its predictors for illness of under-five children

“…Studies show that the nature of the disease, length of stay at hospital, ethnicity,[ 21 ] treatment cost,[ 22 ] and invisible costs like loss of wages and time and travel cost contributed to OOP expenses. [ 23 ]…”

Assessment of Out of Pocket Expenditure and associated factors for availing COVID-19 vaccination by the beneficiaries in Bengaluru: South India

“…Out-of-pocket expenditure in health care includes traveling costs, loss of wages, cost of registration, consultation, hospital charges, and cost of medications, food and lodging of caregivers 6 . Such out-of-pocket expenditures may lead to catastrophic health expenditures, where in the household has to borrow money or sell their property/assets or when they get contributions from friends/relatives to meet their health care expenses 7…”

“…5 Out-of-pocket expenditure in health care includes traveling costs, loss of wages, cost of registration, consultation, hospital charges, and cost of medications, food and lodging of caregivers 6 . Such out-of-pocket expenditures may lead to catastrophic health expenditures, where in the household has to borrow money or sell their property/assets or when they get contributions from friends/relatives to meet their health care expenses 7 India began its largest COVID 19 vaccination drive on 16 th January 2021 to cover health care and frontline workers and scaled up to cover citizens above 45 years of age. The Government of India had selected the priority groups based on the potential availability of vaccines.…”

Assessment of Household Out-of-pocket (OOP) Contributions to Health Expenditure in Niger State North Central Nigeria

“…Health financing in Low-and Middle-Income Countries (LMICs) and individuals' access to essential health services depends on Out-of-Pockets (OOPs) [4]. The term 'out-of-pockets (OOP) payment has been defined as the summation of all kinds of direct expenditure or expenses incurred at the point of receiving health care directly made by households either as in patient or outpatient [5,6]. OOPs involves payment for health care at the point of service.…”

“…Studies in India documented out-of-pocket expenditure as one of the hidden costs experienced by households and could be an impediment to vaccination coverage [5]. Other studies in Africa show out of pocket expenditure accounting for between 48% -66% burden of health care expenditure in Africa [21,22].…”