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Does choice of health care facility matter? Assessing out-of-pocket expenditure and catastrophic spending on emergency obstetric care in India

Published online by Cambridge University Press:  25 June 2020

Jalandhar Pradhan Open the ORCID record for Jalandhar Pradhan [Opens in a new window]  and
Sasmita Behera
Jalandhar Pradhan*
Affiliation:
Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, India
Sasmita Behera
Affiliation:
Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, India
*
*Corresponding author. Email: jpp_pradhan@yahoo.co.uk
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Abstract

The key recommendation of the Child Survival and Safe Motherhood programme was the provision of Emergency Obstetric Care (EmOC) for the prevention of maternal mortality, especially in developing countries like India. The objectives of this paper were three-fold: to examine the socioeconomic differentials in mean out-of-pocket expenditure on EmOC in public and private health care facilities in India; to evaluate the catastrophic health expenditure of households at the threshold levels of 5% and 10%; and finally, to assess the effects of various socioeconomic and demographic covariates on the levels of catastrophic health expenditure on EmOC. Data were extracted from the 71st round of the National Sample Survey Office (NSSO) survey conducted in India between January and June 2014. A stratified multi-stage sampling design was followed to conduct the survey. The information was collected from 65,932 households (rural: 36,480; urban: 29,452) and 33,104 individuals across various states and union territories in India. However, the present study had taken only 1653 sample women who availed EmOC care during the last one year preceding the survey date. Binary logistic regression was applied. Large differences in out-of-pocket expenditure on EmOC were found between private and public health care facilities. Mean annual out-of-pocket expenditure by women in private hospitals was INR 23,309 (US$367), which was about 6 times higher than in public hospitals, where mean spending was INR 3651 (US$58). Furthermore, logistic regression analysis showed a significant association between household socioeconomic status and level of catastrophic health expenditure on EmOC. The odds of catastrophic health expenditure in public health facilities among women from the North region were higher than among those from the Central, South and West regions. Age and level of education significantly influenced the mean level of catastrophic health expenditure. Access to good-quality obstetric care is key to reducing the maternal mortality rate and child deaths, and thus achieving Sustainable Development Goal 3. There is an urgent need for policy interventions to reduce the financial burden of households in accessing obstetric care in India.

Keywords

Catastrophic health expenditureObstetric careIndia
Type
Research Article
Information
Journal of Biosocial Science , Volume 53 , Issue 4 , July 2021 , pp. 481 - 496
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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