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Out-of-pocket expenditure and catastrophic health spending on maternal care in public and private health centres in India: a comparative study of pre and post national health mission period

Author

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  • Sanjay K. Mohanty

    (Department of Fertility Studies, International Institute for Population Sciences (IIPS))

  • Anshul Kastor

    (International Institute for Population Sciences)

Abstract

Background The National Health Mission (NHM), one of the largest publicly funded maternal health programs worldwide was initiated in 2005 to reduce maternal, neo-natal and infant mortality and out-of-pocket expenditure (OOPE) on maternal care in India. Though evidence suggests improvement in maternal and child health, little is known on the change in OOPE and catastrophic health spending (CHS) since the launch of NHM. Aim The aim of this paper is to provide a comprehensive estimate of OOPE and CHS on maternal care by public and private health providers in pre and post NHM periods. Data and method The unit data from the 60th and 71st rounds of National Sample Survey (NSS) is used in the analyses. Descriptive statistics is used to understand the differentials in OOPE and CHS. The CHS is estimated based on capacity to pay, derived from household consumption expenditure, the subsistence expenditure (based on state specific poverty line) and household OOPE on maternal care. Data of both rounds are pooled to understand the impact of NHM on OOPE and CHS. The log-linear regression model and the logit regression models adjusted for state fixed effect, clustering and socio-economic and demographic correlates are used in the analyses. Results Women availing themselves of ante natal, natal and post natal care (all three maternal care services) from public health centres have increased from 11% in 2004 to 31% by 2014 while that from private health centres had increased from 12% to 20% during the same period. The mean OOPE on all three maternal care services from public health centres was US$60 in pre-NHM and US$86 in post-NHM periods while that from private health center was US$170 and US$300 during the same period. Controlling for socioeconomic and demographic correlates, the OOPE on delivery care from public health center had not shown any significant increase in post NHM period. The OOPE on delivery care in private health center had increased by 5.6 times compared to that from public health centers in pre NHM period. Economic well-being of the households and educational attainment of women is positively and significantly associated with OOPE, linking OOPE and ability to pay. The extent of CHS on all three maternal care from public health centers had declined from 56% in pre NHM period to 29% in post NHM period while that from private health centres had declined from 56% to 47% during the same period. The odds of incurring CHS on institutional delivery in public health centers (OR .03, 95% CI 0.02, 06) and maternal care (OR 0.06, 95% CI 0.04, 0.07) suggest decline in CHS in the post NHM period. Women delivering in private health centres, residing in rural areas and poor households are more likely to face CHS on maternal care. Conclusion NHM has been successful in increasing maternal care and reducing the catastrophic health spending in public health centers. Regulating private health centres and continuing cash incentive under NHM is recommended.

Suggested Citation

  • Sanjay K. Mohanty & Anshul Kastor, 2017. "Out-of-pocket expenditure and catastrophic health spending on maternal care in public and private health centres in India: a comparative study of pre and post national health mission period," Health Economics Review, Springer, vol. 7(1), pages 1-15, December.
    • Handle: RePEc:spr:hecrev:v:7:y:2017:i:1:d:10.1186_s13561-017-0167-1
    DOI: 10.1186/s13561-017-0167-1
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    References listed on IDEAS

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    1. Government of India, 2017. "National Health Policy 2017," Working Papers id:11664, eSocialSciences.
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    5. Ahmed Rashad & Mesbah Sharaf, 2015. "Catastrophic and Impoverishing Effects of Out-Of-Pocket Health Expenditure: New Evidence from Egypt," Working Papers 974, Economic Research Forum, revised Nov 2015.
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    1. Laishram Ladusingh & Sanjay Kumar Mohanty & Melody Thangjam, 2018. "Triple burden of disease and out of pocket healthcare expenditure of women in India," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-13, May.
    2. Sanjay K. Mohanty & Suraj Maiti & Santosh Kumar Sharma & Laxmi Kant Dwivedi & Niranjan Saggurti, 2023. "Assessing the impact of measurement error in household consumption on estimates of catastrophic health expenditure in India," Palgrave Communications, Palgrave Macmillan, vol. 10(1), pages 1-12, December.
    3. Rinshu Dwivedi & Jalandhar Pradhan & Ramesh Athe, 2021. "Measuring catastrophe in paying for healthcare: A comparative methodological approach by using National Sample Survey, India," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(5), pages 1887-1915, September.
    4. Pu, Christy & Lee, Miaw-Chwen & Hsieh, Tsung-Che, 2023. "Income-related inequality in out-of-pocket health-care expenditures under Taiwan's national health insurance system: An international comparable estimation based on A System of Health Accounts," Social Science & Medicine, Elsevier, vol. 326(C).
    5. Mohanty, Sanjay K. & Panda, Basant Kumar & Khan, Pijush Kanti & Behera, Priyamadhaba, 2019. "Out-of-pocket expenditure and correlates of caesarean births in public and private health centres in India," Social Science & Medicine, Elsevier, vol. 224(C), pages 45-57.
    6. Rajesh Kamath & Helmut Brand & Nisha Nayak & Vani Lakshmi & Reena Verma & Prajwal Salins, 2023. "District-Level Patterns of Health Insurance Coverage and Out-of-Pocket Expenditure on Caesarean Section Deliveries in Public Health Facilities in India," Sustainability, MDPI, vol. 15(5), pages 1-17, March.
    7. Bhattacharyya, Bhaskar & Mandal, Biswajit & Sengupta, Sarbajit, 2022. "Correlates of Distress Financing In Case of Institutional Delivery In India: Evidence From The National Family Health Survey," MPRA Paper 116652, University Library of Munich, Germany.
    8. Dipti Govil & Sanjay Kumar Mohanty & Pralip Kumar Narzary, 2020. "Catastrophic household expenditure on caesarean deliveries in India," Journal of Population Research, Springer, vol. 37(2), pages 139-159, June.
    9. Jeetendra Yadav & Geetha R. Menon & Denny John, 2021. "Disease-Specific Out-of-Pocket Payments, Catastrophic Health Expenditure and Impoverishment Effects in India: An Analysis of National Health Survey Data," Applied Health Economics and Health Policy, Springer, vol. 19(5), pages 769-782, September.

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