Cost of Deliveries among Health Insurance (HI) Enrollees and Out-of-Pocket (OOP) Payers Accessing Maternal Healthcare Services in a Tertiary Health Institution in Southwest Nigeria
Abstract:
Maternal mortality is currently high
and remains one of the most important public health problems in developing countries.
This study determined the cost of vaginal and caesarean section deliveries among
Health Insurance (HI) enrollees and Out-of-Pocket (OOP) payers. A comparative cross-sectional
study was carried out among 380 women {(133 vaginal and 57 caesarean section deliveries
among each of HI enrollees and OOP payers)} who accessed delivery services in a
tertiary health institution in Southwest Nigeria using a systematic random sampling
technique. Data was gathered using an interviewer-administered semi-structured questionnaire
and analyzed using IBM SPSS version 23. P-value <0.05
was taken as significant. The
overall mean age of respondents in this study was 36.5 ± 4.7years among the vaginal
delivery respondents and 35.8 ± 3.6 years among caesarean section delivery respondents.
The mean total cost of vaginal delivery for HI enrollees {₦14,238.5 ± 4,809.0 ($34.5
± 12.7)} is lesser than for OOP payers {₦37,928.5 ± 19,813.0 ($99.8 ± 52.1)}. Furthermore,
the mean total cost of caesarean section delivery for HI enrollees {₦14,238.5 ±
4,809.0 ($34.5 ± 12.7)} is lesser than for OOP payers (₦37,928.5 ± 19,813.0 ($99.8
± 52.1}. 94.1% of the non-insurance enrollees were willing to join Health Insurance
Scheme. It was concluded that the total cost of vaginal and caesarean section deliveries
is lower among the Health Insurance enrollees than the Out-of-Pocket payers. Therefore,
intervention to increase awareness on health insurance is recommended.
References:
[1]
Nahar
S, Costello, A. The hidden cost of `free' maternity care in Dhaka, Bangladesh.
Health Policy and Planning. 1998; 13(4): 417 – 422. Oxford University Press
1998.
[2]
Simkhada
P, Teijlingen EV, GauSharma G, Simkhada B, Townend J. User costs and informal
payments for care in the largest maternity hospital in Kathmandu, Nepal. Health
Science Journal. 2012; 6(2): 317-334.
[3]
Sambo
MN, Abdulrazaq GA, Shamang, AF, Ibrahim AA. Household cost of antenatal care
and delivery services in a rural community of Kaduna state, Northwest Nigeria.
Niger Med Journal. 2013; 54(2): 87-91.
[4]
FGN.
Federal Government of Nigeria. Workshop for Nigerian actors on improving
financial access to Maternal, Newborn, Child Health (MNCH) services for the
Poor in Nigeria. Technical Report. Tinapa Calaba. 2016; Pg 1-64.
[5]
Kalu-Umeh
NN, Sambo MN, Idris SH, Kurfi AM. Costs and Patterns of Financing Maternal
Health Care Services in Rural Communities in Northern Nigeria: Evidence for
Designing National Fee Exemption Policy. International Journal of MCH and AIDS.
2013; 2(1): 163-172.
[6]
WHO.
World Health Organization. Social Health Insurance: Sustainable health
Financing, Universal Coverage and Social health Insurance. Fact sheet No 320.
2005. Available from: http://www.who.int/ha. [Last accessed on February 2021].
[7]
Adeniran
AS, Aun II, Fawole AA, Aboyeji AP. Comparative analysis of caesarean delivery
among out-of-pocket and health insurance clients in Ilorin. Nigeria. Niger
Postgrad Med J. 2020; 27: 108-14.
[8]
Aregbesola,
B. Healthcare in Nigeria: Challenges and recommendations.
Sociialprotection.org. 2020. Available online at http://sociialprotection.org/discover/blog/health-care-nigeria-challenges-and-recommendations.
[9]
Aderibigbe
SA, Wit FW, van Hensbroek MB, Osagbemi G.K, Akande TM. The effect of health
insurance on maternal and child health: A systematic review. J Med Trop. 2018;
20: 83-92.
[10]
Roberts
AA, Agboola BC, Oshunniyi L, Roberts OY. Health Insurance and User Fees: A
Survey of Health Service Utilization and Payment Methods in Mushin LGA, Lagos,
Nigeria. Ann Med Health Sci Res. 2018; 8: 93-99.
[11]
Youngji
JO, Alland K, Ali H, Mehra S, LeFevre ME, Pak SE, et al. Antenatal care in
rural Bangladesh: current state of costs, content and recommendations for
effective service delivery. BMC Health Services Research. 2019; 19: 861-872. https://doi.org/10.1186/s12913-019-4696-7.
[12]
Callender
E, Shand A, Ellwood D, Fox H, Nassar N. Financing Maternity and Early Childhood
Healthcare in The Australian Healthcare System: Costs to Funders in Private and
Public Hospitals Over the First 1000 Days. Int J Health Policy Manag. 2020;
x(x): 1–10. doi 10.34172/ijhpm.2020.68.
[13]
Borghi
J, Bastus S, Belizan M, Carroli G, Hutton G, Fox-Rushby J. 2003. Costs of
Publicly Provided Maternity Services in Rosario, Argentina. Salud pública de
méxico. 2003; 45(1): 27-34.
[14]
Bonu
S, Bhushan I, Rani M, Anderson I. Incidence and correlates of ‘catastrophic’
maternal health care expenditure in India. Health Plann Policy 2009; 24:
445–56.
[15]
Govil
D, Purohit N, Gupta SD, Mohanty SK. Out-of-pocket expenditure on prenatal and
natal care post Janani Suraksha Yojana: a case from Rajasthan, India. Journal
of Health, Population and Nutrition. 2016; 35: 15- 46.
[16]
Zaman
S, Khan A. Costs of vaginal delivery and caesarean section at a tertiary level
public hospital in Islamabad, Pakistan. BMC Pregnancy and Childbirth. 2010;
10(2): 1-8.
[17]
Mukherjee
S, Singh A. Has the Janani Suraksha Yojana (a conditional maternity benefit
transfer scheme) succeeded in reducing the economic burden of maternity in
rural India? Evidence from the Varanasi district of Uttar Pradesh. Journal of
Public Health Research. 2018; (7): 957-963.
[18]
Awoyemi,
BO. The Rate and Costs of Caesarean Section among Women in Ado-Ekiti, Nigeria.
Health Econ Outcome Res Open Access.2020; 6(3): 001-005.
[19]
Sarker
AR, Sultana M, Ali N, Akram R, Sheikh N, Mahumud R A, et al. Cost comparison
and determinants of out‐of‐ pocket payments on child delivery care in
Bangladesh. Int J Health Plann Mgmt. 2018; 1–18.
[20]
Odhiambo
J, Ruhumuriza J, Nkurunziza T, Riviello R, Shrime M, Lin Y, et al. Health
Facility
Cost of Caesarean Delivery at a Rural
District
Hospital in Rwanda Using Time-Driven Activity-Based Costing. Maternal and Child
Health Journal. 2019. 1-7. https://doi.org/10.1007/s10995-018-2674-z.
[21]
Ekiti
State Government. History of Ekiti State. (2016) Available at
http://ekitistate.gov.ng. [Last Accessed on January 2, 2021].
[22]
Federal
Teaching Hospital Ido-Ekiti. Available at www.fethi.gov.ng (Last accessed, January 2021).
[23]
WHO.
World Health Organization. Health Systems Financing: The Path to Universal
Coverage. Geneva. 2010; 1-50.
[24]
Mbuli
MD, Awolu MM, Asangbeng TE., Mbuli IA, Pangmekeh PJ, Shey ND. The Influence of
Health Insurance on the Utilization of Maternal Health Care Services in Kumba
Health District: A Community-based Assessment. BioRxiv; 2018; 1-18. doi: https://doi.org/10.1101/474130.
[25]
Matsubara
C, Nguyen TA, Murakami H. Exploring affordability and healthcare-seeking
behaviour for delivery and antenatal care among the poor and ethnic minorities
in rural Northwestern Vietnam. Global Health Action. 2019; 12: 1-9 DOI:
10.1080/16549716.2018.1556573.
[26]
Goli
S, Rammohan A, Moradhvaj I: Out-of-pocket expenditure on maternity care for
hospital births in Uttar Pradesh, India. Health Economics Review Springer,
Heidelberg. 2018; 8(5): 1-16. http://dx.doi.org/10.1186/s13561-018-0189-3.