Cost-comparison and determinants of out-of-pocket payments on child delivery care in Bangladesh

Sarker, Abdur Razzaque and Sultana, Marufa and Ali, Nausad and Akram, Md Raisul and Sheikh, Nurnabi and Mahumud, Rashidul Alam and Morton, Alec (2018) Cost-comparison and determinants of out-of-pocket payments on child delivery care in Bangladesh. International Journal of Health Planning and Management, 33 (4). e1232–e1249. ISSN 1099-1751 (

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Objectives: The objective of this study is to capture the relevant out-of-pocket costs, coping mechanisms, and associated factors that are related to child delivery in Bangladesh through the use of nation-wide household level data. Methods: The study was conducted using a secondary data source of the latest Bangladesh Demographic and Health Survey (DHS) 2014. A cross-sectional survey was carried out for six months, from June to November 2014, where closed-ended questions regarding child delivery related expenditure were included. Log linear regression and descriptive analysis methods were used to analyse this data. Results: Analysis indicated that the average self-reported out-of-pocket payment (OOPP) per child delivery was US$ 79.23 (SD ±128.05). The highest OOP was observed for C-section (US$ 249.89, SD ±153.54), followed by institutional normal delivery (US$ 61.62, SD ±75.28). The average cost per normal home delivery was US$ 15.89 (SD ±25.84). The richest quintile spent significantly more than the poorest quintile with regards to C-Section (US$ 281 vs. US$ 204), normal delivery at an institution (US$ 80 vs. US$ 65), and even normal delivery at home (US$ 22 vs. US$ 13). Conclusions: The study showed that there was a huge variation of OOP which was dependent on the facility and socio-economic demographic status of the households. As such, policy efforts need to focus on lowest wealth quintiles to avoid economic burdens during child delivery related activities, and therefore, financial risk protection should be provided. Social health insurance might be an option for financing during child delivery, which is in line with the core objective of the Healthcare Financing Strategy of Bangladesh, which is to achieve Universal Health Coverage.