Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal

被引：28

作者：

Acharya, Jeevan ^{[1
]}

Kaehler, Nils ^{[2
]}

Marahatta, Sujan Babu ^{[3
]}

Mishra, Shiva Raj ^{[4
]}

Subedi, Sudarshan ^{[5
]}

Adhikari, Bipin ^{[6
]}

机构：

[1] Pokhara Univ, La Grandee Int Coll, Pokhara, Nepal

[2] Sandefjord Helsepk, Skiringssalveien 20, Sandefjord, Norway

[3] Manmohan Mem Med Coll & Teaching Hosp, Dept Community Med, Kathmandu, Nepal

[4] Univ Western Australia, Sch Populat Hlth, Crawley, WA, Australia

[5] Pokhara Univ, Sch Hlth & Allied Sci, Kaski, Nepal

[6] Mahidol Univ Int Coll, Mahidol Oxford Trop Med Res Unit, Fac Trop Med, Bangkok 10700, Thailand

来源：

PLOS ONE | 2016年 / 11卷 / 06期

关键词：

MATERNITY CARE;

D O I：

10.1371/journal.pone.0157746

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Introduction Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs. Methods A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study. Results The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar) and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%), clothes (9.8%) and transport (7.3%). For postpartum women with their husband or house head, the total mean opportunity cost of "days of work loss" were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007), employed house head (p = 0.011), monthly family income more than 25,000 NRs (Nepalese Rupees) (p = 0.014), private hospital as a place of delivery (p = 0.0001), C-section as a mode of delivery (p = 0.0001), longer duration (>5 days) of stay in hospital (p = 0.0001), longer distance (>15 km) from house to hospital (p = 0.0001) and longer travel time (>240 minutes) from house to hospital (p = 0.007) showed a significant association with the higher hidden costs (>25000 NRs). Conclusion Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time) were associated with hidden costs. Hidden costs can be a critical factor for many poor and remote households who attend the hospital for delivery. Current remuneration (10-15 USD for normal delivery, 30 USD for complicated delivery and 70 USD for caesarean section delivery) for maternity incentive needs to account the hidden costs by increasing it to 250 USD for normal delivery and 350 USD for C-section. Decentralization of the obstetric care to remote and under-privileged population might reduce the economic burden of pregnant women and can facilitate their attendance at the health care centers.

引用

页数：11

共 26 条

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