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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2019

Open Access 01-12-2019 | Research

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

Authors: Suyash Mishra, Sanjay K. Mohanty

Published in: International Journal for Equity in Health | Issue 1/2019

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Abstract

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 socio-economic 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.
Footnotes
1
Public source include government/municipal hospital, government dispensary, urban health centers, community health centers, sub-centers, rural hospital and other public health facilities while private source include hospitals, maternity home, clinic, non-governmental organization (NGO), trust hospital, clinic and other private sector facility.
 
2
Wealth quintile was derived from the wealth index that was created using Principal Component Analysis (PCA) for a set of 43 consumer durables for rural and urban areas separately. The consumer durables included source of drinking water, type of toilet facility, type of cooking fuel, main material of floor, main roof material and others household assets.
 
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Metadata
Title
Out-of-pocket expenditure and distress financing on institutional delivery in India
Authors
Suyash Mishra
Sanjay K. Mohanty
Publication date
01-12-2019
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2019
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-019-1001-7

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