To quantify the economic burden of maternal health care services on Indian households and examine the levels of expenditure incurred in public and private health care institutions at the national, state and community levels. Cross-sectional population data from the 2004 National Sample Survey Organisation were used, which considered 9,643 households for the analysis where at least one woman received maternal health care services during the year preceding the survey. Multilevel linear regression techniques were used to estimate the effect of household, cluster and state characteristics on the proportion of maternal health care expenditures over total household expenditures. Over 80 % of households reported paying for maternal health care services, with those using private care facilities paying almost 4 times more than those using public facilities. Multilevel analyses show evidence of high burden of maternal health care expenditures, which varied significantly across states according to the level of health care utilisation, and with considerable heterogeneity at the household and community levels. Maternal health care services in India are offered free at the point of delivery, yet many families face significant out-of-pocket expenditures. The recent governmental policy interventions to encourage institutional births by providing nominal financial assistance is a welcome step but this might not help to compensate mothers for other indirect expenditures, especially those living in rural areas and poorer communities who are increasingly seeking care in private facilities.

译文

量化孕产妇保健服务对印度家庭的经济负担,并检查国家,州和社区各级公共和私人保健机构的支出水平。使用了2004全国抽样调查组织的横断面人口数据,该数据考虑了9,643家庭进行分析,其中至少有一名妇女在调查前一年接受了孕产妇保健服务。使用多级线性回归技术来估计家庭,集群和州特征对孕产妇保健支出占家庭总支出的比例的影响。超过80% 的家庭报告为孕产妇保健服务付费,使用私人护理设施的家庭付费几乎是使用公共设施的家庭付费的4倍。多层次分析表明,孕产妇保健支出负担很高,根据保健利用水平,各州之间的差异很大,并且在家庭和社区层面具有相当大的异质性。印度的产妇保健服务在分娩时免费提供,但许多家庭面临着大量的自付费用。最近的政府政策干预措施通过提供名义财政援助来鼓励机构分娩是一个可喜的步骤,但这可能无助于补偿母亲的其他间接支出,特别是那些生活在农村地区和贫困社区的母亲,他们越来越多地在私人设施中寻求护理。

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