"Catastrophic" maternal health care expenditure in India.
Article Type: Brief article
Subject: Maternal health services (Economic aspects)
Medical care, Cost of (Reports)
Pub Date: 05/01/2010
Publication: Name: Reproductive Health Matters Publisher: Reproductive Health Matters Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2010 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2010 Source Volume: 18 Source Issue: 35
Geographic: Geographic Scope: India Geographic Code: 9INDI India
Accession Number: 236247746
Full Text: Using data from the 60th round of the National Sample Survey of India (2004), this study investigated catastrophic maternal expenditure in India. Data come from 6,879 births that took place in the year prior to the survey. Catastrophic maternal expenditure was measured as: (i) maternal health care expenditure more than 10% of annual household expenditure (ME-1), and (ii) maternal health care expenditure of more than 40% of the annual capacity to pay (ME-2). Capacity to pay was defined as total annual household consumption minus subsistence expenditure, e.g. on food and other basic needs, and was considered zero for households below the poverty line. The average maternal expenditure varied by place of delivery: US$9.50 for birth at home, US$24.70 in a public facility and and US$104.30 in a private facility. Catastrophic expenditure was very common, with 16% of households spending more than ME-1 and 51% incurring ME-2. Incidence of expenditure of more than 10% of annual household expenditure increased with increased income, bur the reverse was seen for expenditure of more than 40% of the annual capacity to pay, showing higher non-use of institutional maternal care by poorer households due to inability to pay. All the households from the poorest decile and 99% from the second poorest decile incurred ME-2. Measuring maternal expenditure against "capacity to pay" (ME-2) may be the better measure when assessing these financial constraints. Improving the performance of the public sector, appropriate regulation of and partnership with the private sector, and effective direct cash transfers to pregnant women in the poorest households may increase maternal service use and reduce the considerable financial distress associated with maternal expenditure. (1)

(1.) Bonu S, Bhushan I, Rani M, et al. Incidence and correlates of "catastrophic" maternal health care expenditure in India. Health Policy and Planning 2009;24(6):445-56.
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