ArticleInternational journal for equity in health2019
Out-of-pocket expenditure and distress financing on institutional delivery in India.
Article in International journal for equity in health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
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Who cites it
35 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Understanding out-of-pocket expenditure in India: a systematic review.Frontiers in public health · 2025Pooled it
- Biosimilar anti-vascular endothelial growth factor agents: Clinical outcomes, safety, and cost-effectiveness in India.Indian journal of ophthalmology · 2026Review
- One size does not fit all: income-sensitive thresholds for catastrophic health expenditure.Health policy and planning · 2026Article
- Socioeconomic differences and determinants of reimbursable out-of-pocket expenditures: a prospective cohort study within the BabyGel trial.BMJ public health · 2026Article
- Impact of out-of-pocket health expenditure on poverty in India.Frontiers in public health · 2026Article
- Caesarean deliveries and their impact on financial burden and quality of life among post-partum mothers in Tamil Nadu, India.PloS one · 2026Article
- Distress financing on inpatient health expenditure across States in India.BMC health services research · 2025Article
- Determinants of medical borrowing and associated inequalities in the Kingdom of Saudi Arabia: evidence from the Global Findex survey.Health economics review · 2025Article
- Determinants of distress financing for healthcare service utilization: a convergent mixed-method study at a tertiary hospital in Malaysia.Health policy and planning · 2025Article
- Out-of-Pocket Expenditure (OOPE) Among COVID-19 Patients by Insurance Status in a Quaternary Hospital in Karnataka, India.International journal of environmental research and public health · 2025Article
- Private sector delivery of care for maternal and newborn health: trends over a decade in the Indian state of Bihar.BMC medicine · 2025Article
- Perinatal mental health in India in the states of Haryana and Telangana: A district-level situational analysis.Global mental health (Cambridge, England) · 2025Article
- Trends in nulliparous singleton alive births by cesarean section in India: Empirical patterns across public and private hospitals for 720 districts, 2016-2021.PLOS global public health · 2025Article
- Catastrophic health expenditure among households with differently abled children and adolescents in Puducherry, India: a mixed-method study.Frontiers in public health · 2025Article
- "International journal of environmental research and public health · 2024Article
- Making the health system work for over 25 million births annually: drivers of the notable decline in maternal and newborn mortality in India.BMJ global health · 2024Article
- Determinants of public institutional births in India: An analysis using the National Family Health Survey (NFHS-5) factsheet data.Journal of family medicine and primary care · 2024Article
- Are institutional deliveries equitable in the southern states of India? A benefit incidence analysis.International journal for equity in health · 2024Article
- Out of pocket expenditure and distress financing on cesarean delivery in India: evidence from NFHS-5.BMC health services research · 2023Article
- Out-of-pocket expenditure and its correlates for institutional deliveries in private and public healthcare sectors in India: findings from NFHS 5.BMC public health · 2023Article
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Abstract
backgroundDespite large investment in central and state sponsored schemes for maternal care, out-of-pocket expenditure (OOPE) and catastrophic health spending (CHS) on institutional delivery remain high over time, across states and across socio-economic groups. Though many studies have examined the OOPE and CHS, few studies have examined the nature and extent of distress financing on institutional delivery in India. DATA: Data from the fourth round of National Family Health Survey (NFHS 4), 2015-16 was used for the analysis. Distress financing was defined as borrowing money or selling assets to meet the OOPE on delivery care. Composite variables, descriptive analyses, concentration index (CI), concentration curve (CC) and predicted probability were used to estimate the extent of distress financing for institutional delivery in India.
resultsThe OOPE on institutional delivery has strong economic and educational gradient. One in four mothers resorted to borrowing or selling to meet the OOPE on institutional delivery. The extent of distress financing on institutional delivery was high in poorer state of Bihar and Odisha and in the state of Telangana that had highest prevalence of caesarean delivery. Savings was more prevalent among mothers compared to those who met the OOPE by borrowing/selling of assets. Finding are robust across the states of India. The predicted probability of incurring distress financing was 0.31 among mothers belonging to the poorest wealth quintile compared to 0.09 in the richest quintile, and 0.40 for those who incurred OOPE of more than INR 20,000. The probability of incurring distress financing was higher for mothers who had caesarean birth, delivered in private health centers and incurred high OOPE on institutional delivery.
conclusionDistress financing on institutional delivery was higher among the less educated, poor and in private health centers. Increasing use of public health centers, reducing caesarean births, improving the availability of medicine and diagnostic services can reduce the extent of distress financing in India.
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