The magnitude of out‐of‐pocket expenditure for antenatal care in low and middle‐income countries: A systematic review and meta‐analysis

Gunarathne, Sajaan Praveena; Wickramasinghe, Nuwan Darshana; Agampodi, Thilini Chanchala; Prasanna, Indika Ruwan; Agampodi, Suneth Buddhika

doi:10.1002/hpm.3578

Cited by 8 publications

(17 citation statements)

References 94 publications

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“…Moreover, the present study reports that pregnant women with one or more maternal morbidities/ill-health conditions tend to have more OOPE compared with pregnant women who do not report any ill-health conditions, which is in accordance with the previous literature (70). However, compared with the range of OOPE for maternal morbidities during total pregnancy in LMICs reported in the recent meta-analysis (USD 125.98 to USD 523.03) (25), the OOPE for maternal morbidities during pregnancy (USD 36.68) reported in the present study is substantially low. Further, it is much lower than the OOPE reported in India (USD 262.25) (71) and Ethiopia (USD 125.98) (72).…”

Section: Discussionsupporting

confidence: 92%

“…The per visit OOPE for ANC of the present study (USD 4.18) is within the range of the magnitude of OOPE for a single ANC visit (USD 2.65 to USD 194.37) reported in the recent systematic review and meta-analysis conducted in LMICs (25). However, it is much lower than the OOPE for a single ANC visit (USD 12.93) in LMICs.…”

Section: Discussionsupporting

confidence: 79%

“…This could be due to the country-speci c socio-political and cultural priority for maternal care. Further, not all countries included in the systematic review provide free maternal health services, which may have led to a higher magnitude due to the paid health service utilization (25). Further, compared with the other countries which practice free maternal healthcare/national programs for reducing maternal OOPE, the present study still shows a lower OOPE than in Ghana (27), Malawi and Uganda (49), Bangladesh (50), and Argentina (51).…”

Section: Discussioncontrasting

confidence: 56%

“…As in the per visit OOPE, the total OOPE during pregnancy in rural Sri Lanka (USD 57.74) is also lower than the pooled estimate of USD 63.29 reported in LMICs (25). Further, it is noted that the value is even lower than the pooled estimate of USD 60.83 in the South-East Asia Region (SEAR) (25). Even though the magnitude of the present study is lower, it is within the range of OOPE for LMICs (USD 2.41 to USD 654.32) and SEAR (USD 27.11 to USD 654.32) (25), and there was no statistically signi cant difference between the OOPE magnitude of the present study and the OOPE for ANC in LMICs (p>0.05) and SEAR (p>0.05).…”

Section: Discussionmentioning

confidence: 59%

“…This could be the possible reason for the observed lower OOPE compared with other LMICs. As in the per visit OOPE, the total OOPE during pregnancy in rural Sri Lanka (USD 57.74) is also lower than the pooled estimate of USD 63.29 reported in LMICs (25). Further, it is noted that the value is even lower than the pooled estimate of USD 60.83 in the South-East Asia Region (SEAR) (25).…”

Section: Discussionmentioning

confidence: 69%

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Out-of-pocket Expenditure for Antenatal Care Instills amidst Free Health Care Provision: Evidence from a Large Pregnancy Cohort in Rural Sri Lanka

Gunarathne

Wickramasinghe

Agampodi

et al. 2022

Preprint

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Background: Out-of-pocket expenditure (OOPE) considers a barrier to access to healthcare for pregnant women. This study aimed to estimate the magnitude and associated factors of OOPE for antenatal care (ANC) in a rural Sri Lankan setting. Methods: This study was a follow-up of a large pregnancy cohort [Rajarata Pregnancy Cohort (RaPCo)] in all 22 Medical Officers of Health areas in the Anuradhapura District, Sri Lanka. A pre-tested interviewer-administered questionnaire was used to collect data on socio-demographic, economic, and the cost incurred in the first trimester, and self-administered questionnaires were used monthly to collect costs incurred in the second and third trimesters. In-depth financial information of 1,558 pregnant women was analyzed using descriptive statistics for the magnitude, non-parametric statistical methods for statistically significant difference, and the multiple linear regression model to test the associated factors. Results: The mean (SD)]age of the pregnant women was 28.3 (5.6) years. The mean (SD) monthly household income and expenditure were USD 277.29 (216.04) and USD 190.19 (103.11), respectively. The mean OOPE for per visit ANC was USD 4.18 (52.1% of per day household expenditure). The mean OOPE for total ANC was USD 57.74 (3.4% of annual household expenditure). The direct medical OOPE share (73.8%) was significantly higher than direct non-medical OOPE (26.2%) (p<0.001). Pregnant women who utilized only the government-free health services also spent 28% and 14% of OOPE on medicines and laboratory investigations. Monthly household income (p<0.001), monthly household expenditure (p<0.1), used healthcare mode (p<0.05), having maternal morbidities (p<0.05), and the number of previous pregnancies (p<0.1) were the statistically significant independent predictors of OOPE during ANC.Conclusion: Per visit OOPE for ANC is equivalent to half of the per day household expenditure. Monthly household income, expenditure, used healthcare mode, maternal morbidities, and the number of previous pregnancies are independent predictors of OOPE during ANC. Despite having freely available government health facilities, the majority tend to use private health facilities and incur higher OOPE. Government-free healthcare users also incur a direct medical OOPE for medicines and laboratory investigations.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 79%

Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 69%

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Out-of-pocket Expenditure for Antenatal Care Instills amidst Free Health Care Provision: Evidence from a Large Pregnancy Cohort in Rural Sri Lanka

Gunarathne

Wickramasinghe

Agampodi

et al. 2022

Preprint

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Pricing of hospital services: evidence from a thematic review

Sirur,

Pillai K

2024

HEPL

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The management implications of pricing healthcare services, especially hospitals, have received insufficient scholarly attention. Additionally, disciplinary overlaps have led to scattered academic efforts in this domain. This study performs a thematic synthesis of the literature and applies retrospective analysis to hospital service pricing articles to address these issues. The study's inputs were sourced from well-known online repositories, using a structured search string and PRISMA flow chart to select the pertinent documents. Our thematic analysis of pricing literature encompasses: (a) comprehension of hospital service pricing nature; (b) pricing objectives, strategies and practices differentiation; (c) presentation of factors impacting hospital service pricing. We observe that hospital pricing is an intricate and unclear matter. The terms ‘pricing strategies’ and ‘pricing practices’ are often used interchangeably in academic literature. Hospital service pricing is influenced by costs, demand and supply factors, market structure, pricing regulation and third-party reimbursements. The study's findings provide policy implications for service pricing in hospitals, in addition to suggesting avenues for future research on hospital pricing.

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Impact of COVID-19 pandemic on health service utilisation and household economy of pregnant and postpartum women: a cross-sectional study from rural Sri Lanka

et al. 2023

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ObjectivesThis study aims to describe how household economies and health service utilisation of pregnant and postpartum women were affected during the pandemic.DesignA cross-sectional study.SettingThis study was conducted in the Anuradhapura district, Sri Lanka.ParticipantsThe study participants were 1460 pregnant and postpartum women recruited for the Rajarata Pregnancy Cohort during the initial stage of the COVID-19 pandemic.Primary and secondary outcome measuresHousehold economic (income, poverty, nutritional and health expenditures) and health service utilisation details during the COVID-19 pandemic were gathered through telephone interviews. Sociodemographic and economic data were obtained from the cohort baseline and analysed with descriptive and non-parametric analysis.ResultsOut of the 1460 women in the sample, 55.3% (n=807) were pregnant and 44.7% (n=653) were postpartum women. Of the total sample, 1172 (80.3%) women participated in the economic component. The monthly household income (median (IQR)=212.39 (159.29–265.49)) reduced (median (IQR)=159.29 (106.20–212.39)) in 50.5% (n=592) families during the pandemic (Z=−8.555, p<0.001). Only 10.3% (n=61) of affected families had received financial assistance from the government, which was only 46.4% of the affected income. The nutritional expenditure of pregnant women was reduced (Z=−2.023, p=0.043) by 6.7%. During the pandemic, 103 (8.8%) families with pregnant or postpartum women were pushed into poverty, and families who were pushed into poverty did not receive any financial assistance. The majority of women (n=1096, 83.3%) were satisfied with the free public health services provided by the public health midwife during the pandemic.ConclusionDuring the early stages of the pandemic, healthcare utilisation of pregnant women was minimally affected. Even before the country’s current economic crisis, the household economies of pregnant women in rural Sri Lanka were severely affected, pushing families into poverty due to the pandemic. The impact of COVID-19 and the aftermath on pregnant women will have many consequences if the policies and strategies are not revised to address this issue.

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The magnitude of out‐of‐pocket expenditure for antenatal care in low and middle‐income countries: A systematic review and meta‐analysis

Cited by 8 publications

References 94 publications

Out-of-pocket Expenditure for Antenatal Care Instills amidst Free Health Care Provision: Evidence from a Large Pregnancy Cohort in Rural Sri Lanka

Out-of-pocket Expenditure for Antenatal Care Instills amidst Free Health Care Provision: Evidence from a Large Pregnancy Cohort in Rural Sri Lanka

Pricing of hospital services: evidence from a thematic review

Impact of COVID-19 pandemic on health service utilisation and household economy of pregnant and postpartum women: a cross-sectional study from rural Sri Lanka

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