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Out of pocket expenditure and distress financing on cesarean delivery in India: evidence from NFHS-5

BACKGROUND: Though over three-fourths of all births receive medical attention in India, the rate of cesarean delivery (22%) is twice higher than the WHO recommended level. Cesarean deliveries entail high costs and may lead to financial catastrophe for households. This paper examines the out-of-pocke...

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Autores principales: Singh, Rajeev Ranjan, Sharma, Anjali, Mohanty, Sanjay K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10485997/
https://www.ncbi.nlm.nih.gov/pubmed/37679706
http://dx.doi.org/10.1186/s12913-023-09980-w
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author Singh, Rajeev Ranjan
Sharma, Anjali
Mohanty, Sanjay K.
author_facet Singh, Rajeev Ranjan
Sharma, Anjali
Mohanty, Sanjay K.
author_sort Singh, Rajeev Ranjan
collection PubMed
description BACKGROUND: Though over three-fourths of all births receive medical attention in India, the rate of cesarean delivery (22%) is twice higher than the WHO recommended level. Cesarean deliveries entail high costs and may lead to financial catastrophe for households. This paper examines the out-of-pocket expenditure (OOPE) and distress financing of cesarean deliveries in India. METHODS: We used data from the latest round of the National Family Health Survey conducted during 2019–21. The survey covered 636,699 households, and 724,115 women in the age group 15–49 years. We have used 159,643 births those delivered three years preceding the survey for whom the question on cost was canvassed. Descriptive analysis, bivariate analysis, concentration index (CI), and concentration curve (CC) were used in the analysis. RESULT: Cesarean deliveries in India was estimated at 14.08%, in private health centres and 9.96%  in public health centres. The prevalence of cesarean delivery increases with age, educational attainment, wealth quintile, BMI and high for those who had pregnancy complications, and previous birth as cesarean. The OOPE on cesarean births was US$133. It was US$498 in private health centres and US$99 in public health centres. The extent of distress financing of any cesarean delivery was 15.37%; 27% for those who delivered in private health centres compared to 16.61% for those who delivered in public health centres. The odds of financial distress arising due to OOPE on cesarean delivery increased with the increase of OOPE [AOR:10.00, 95% CI, 9.35–10.70]. Distress financing increased with birth order and was higher among those with low education and those who belonged to lower socioeconomic strata. CONCLUSION: High OOPE on a cesarean delivery leads to distress financing in India. Timely monitoring of pregnancy and providing comprehensive pregnancy care, improving the quality of primary health centres to conduct cesarean deliveries, and regulating private health centres may reduce the high OOPE and financial distress due to cesarean deliveries in India. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09980-w.
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spelling pubmed-104859972023-09-09 Out of pocket expenditure and distress financing on cesarean delivery in India: evidence from NFHS-5 Singh, Rajeev Ranjan Sharma, Anjali Mohanty, Sanjay K. BMC Health Serv Res Research BACKGROUND: Though over three-fourths of all births receive medical attention in India, the rate of cesarean delivery (22%) is twice higher than the WHO recommended level. Cesarean deliveries entail high costs and may lead to financial catastrophe for households. This paper examines the out-of-pocket expenditure (OOPE) and distress financing of cesarean deliveries in India. METHODS: We used data from the latest round of the National Family Health Survey conducted during 2019–21. The survey covered 636,699 households, and 724,115 women in the age group 15–49 years. We have used 159,643 births those delivered three years preceding the survey for whom the question on cost was canvassed. Descriptive analysis, bivariate analysis, concentration index (CI), and concentration curve (CC) were used in the analysis. RESULT: Cesarean deliveries in India was estimated at 14.08%, in private health centres and 9.96%  in public health centres. The prevalence of cesarean delivery increases with age, educational attainment, wealth quintile, BMI and high for those who had pregnancy complications, and previous birth as cesarean. The OOPE on cesarean births was US$133. It was US$498 in private health centres and US$99 in public health centres. The extent of distress financing of any cesarean delivery was 15.37%; 27% for those who delivered in private health centres compared to 16.61% for those who delivered in public health centres. The odds of financial distress arising due to OOPE on cesarean delivery increased with the increase of OOPE [AOR:10.00, 95% CI, 9.35–10.70]. Distress financing increased with birth order and was higher among those with low education and those who belonged to lower socioeconomic strata. CONCLUSION: High OOPE on a cesarean delivery leads to distress financing in India. Timely monitoring of pregnancy and providing comprehensive pregnancy care, improving the quality of primary health centres to conduct cesarean deliveries, and regulating private health centres may reduce the high OOPE and financial distress due to cesarean deliveries in India. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09980-w. BioMed Central 2023-09-07 /pmc/articles/PMC10485997/ /pubmed/37679706 http://dx.doi.org/10.1186/s12913-023-09980-w Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Singh, Rajeev Ranjan
Sharma, Anjali
Mohanty, Sanjay K.
Out of pocket expenditure and distress financing on cesarean delivery in India: evidence from NFHS-5
title Out of pocket expenditure and distress financing on cesarean delivery in India: evidence from NFHS-5
title_full Out of pocket expenditure and distress financing on cesarean delivery in India: evidence from NFHS-5
title_fullStr Out of pocket expenditure and distress financing on cesarean delivery in India: evidence from NFHS-5
title_full_unstemmed Out of pocket expenditure and distress financing on cesarean delivery in India: evidence from NFHS-5
title_short Out of pocket expenditure and distress financing on cesarean delivery in India: evidence from NFHS-5
title_sort out of pocket expenditure and distress financing on cesarean delivery in india: evidence from nfhs-5
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10485997/
https://www.ncbi.nlm.nih.gov/pubmed/37679706
http://dx.doi.org/10.1186/s12913-023-09980-w
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