Direct patient costs of maternal care and birth-related complications at faith-based hospitals in Madagascar: a secondary analysis of programme data using patient invoices
Objectives We aimed to determine the rate of catastrophic health expenditure incurred by women using maternal healthcare services at faith-based hospitals in Madagascar. - Design This was a secondary analysis of programmatic data obtained from a non-governmental organisation. - Setting Two faith-bas...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
22 April 2022
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| In: |
BMJ open
Year: 2022, Volume: 12, Issue: 4, Pages: 1-8 |
| ISSN: | 2044-6055 |
| DOI: | 10.1136/bmjopen-2021-053823 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1136/bmjopen-2021-053823 Verlag, lizenzpflichtig, Volltext: https://bmjopen.bmj.com/content/12/4/e053823 
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| Author Notes: | Mara Anna Franke, Rinja Mitolotra Ranaivoson, Mahery Rebaliha, Sahondra Rasoarimanana, Till Bärnighausen, Samuel Knauss, Julius Valentin Emmrich |
| Summary: | Objectives We aimed to determine the rate of catastrophic health expenditure incurred by women using maternal healthcare services at faith-based hospitals in Madagascar. - Design This was a secondary analysis of programmatic data obtained from a non-governmental organisation. - Setting Two faith-based, secondary-level hospitals located in rural communities in southern Madagascar. - Participants All women using maternal healthcare services at the study hospitals between 1 March 2019 and 7 September 2020 were included (n=957 women). - Measures We collected patient invoices and medical records of all participants. We then calculated the rate of catastrophic health expenditure relative to 10% and 25% of average annual household consumption in the study region. - Results Overall, we found a high rate of catastrophic health expenditure (10% threshold: 486/890, 54.6%; 25% threshold: 366/890, 41.1%). Almost all women who required surgical care, most commonly a caesarean section, incurred catastrophic health expenditure (10% threshold: 279/280, 99.6%; 25% threshold: 279/280, 99.6%). The rate of catastrophic health expenditure among women delivering spontaneously was 5.7% (14/247; 10% threshold). - Conclusions Our findings suggest that direct patient costs of managing pregnancy and birth-related complications at faith-based hospitals are likely to cause catastrophic health expenditure. Financial risk protection strategies for reducing out-of-pocket payments for maternal healthcare should include faith-based hospitals to improve health-seeking behaviour and ultimately achieve universal health coverage in Madagascar. |
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| Item Description: | Gesehen am 30.05.2022 |
| Physical Description: | Online Resource |
| ISSN: | 2044-6055 |
| DOI: | 10.1136/bmjopen-2021-053823 |