title: Out-of-pocket expenses borne by the users of obstetric services at government hospitals in Karachi, Pakistan.
abstract: OBJECTIVE
  Financing health services is a challenge for health policy makers world over, especially in developing countries. Alternate mechanisms such as user fees are being proposed. However, there is a feeling that in developing countries, users of government hospitals spend appreciable personal income to obtain "free services" at these facilities.
  
  
  METHODS
  This study aimed to measure the extent and the factors associated with of out-of-pocket expenses borne by the users of obstetric care at government hospitals. It also aimed to determine willingness of consumers to bear out of pocket expenses. It was conducted in three government hospitals in Karachi.
  
  
  RESULTS
  Seven hundred cases were registered in the study. Sixty-five percent of them had a monthly household income of less than Rupees (Rs.) 3000. Overall, users spent mean of Rs. 590 as out-of-pocket expenses for obstetric services. Of this Rs. 330 was spent on drugs and Rs. 24 on user fees. Thirty-nine percent of the patients were willing to spend out of pocket for services provided at government hospital and 39% declined to do so. Of the patients indicating willingness to spend, 98% agreed to do so for drugs.
  
  
  CONCLUSIONS
  The results suggest that considerable expenses are borne out of pocket by the users of government hospitals for supposedly "free services". If user fees are to be increased the government needs to provide services for which the people will pay, such as drugs, otherwise increase in this fees will simply add to financial burden on the users.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi.
authors.forename: M M
authors.initials: MM
authors.lastname: Kadir
authors.forename: A
authors.initials: A
authors.lastname: Khan
authors.forename: S
authors.initials: S
authors.lastname: Sadruddin
authors.forename: S P
authors.initials: SP
authors.lastname: Luby
mesh_terms: D000328:Adult; D005260:Female; D005382:Financing, Personal; D006297:Health Services Accessibility / Q000191:economics*; D006779:Hospitals, Public; D006801:Humans; D013513:Obstetric Surgical Procedures / Q000191:economics*; D009775:Obstetrics and Gynecology Department, Hospital / Q000191:economics*; D010154:Pakistan; D011247:Pregnancy; D012959:Socioeconomic Factors