Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal.
BACKGROUND
Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs.


METHODS
A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study.


RESULTS
The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar) and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%), clothes (9.8%) and transport (7.3%). For postpartum women with their husband or house head, the total mean opportunity cost of "days of work loss" were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007), employed house head (p = 0.011), monthly family income more than 25,000 NRs (Nepalese Rupees) (p = 0.014), private hospital as a place of delivery (p = 0.0001), C-section as a mode of delivery (p = 0.0001), longer duration (>5days) of stay in hospital (p = 0.0001), longer distance (>15km) from house to hospital (p = 0.0001) and longer travel time (>240 minutes) from house to hospital (p = 0.007) showed a significant association with the higher hidden costs (>25000 NRs).


CONCLUSIONS
Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time) were associated with hidden costs. Hidden costs can be a critical factor for many poor and remote households who attend the hospital for delivery. Current remuneration (10-15 USD for normal delivery, 30 USD for complicated delivery and 70 USD for caesarean section delivery) for maternity incentive needs to account the hidden costs by increasing it to 250 USD for normal delivery and 350 USD for C-section. Decentralization of the obstetric care to remote and under-privileged population might reduce the economic burden of pregnant women and can facilitate their attendance at the health care centers.
La Grandee International College, Pokhara University, Pokhara, Nepal.
Jeevan
J
Acharya
Sandefjord Helsepark, Skiringssalveien 20, Sandefjord, Norway.
Nils
N
Kaehler
Department of Community Medicine, Manmohan Memorial Medical College and Teaching Hospital, Kathmandu, Nepal.
Sujan Babu
SB
Marahatta
School of Population Health, University of Western Australia, Crawley, Western Australia, Australia.
Shiva Raj
SR
Mishra
School of Health and Allied Sciences, Pokhara University, Kaski, Nepal.
Sudarshan
S
Subedi
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Bipin
http://orcid.org/0000-0001-8981-3910
B
Adhikari
D000328:Adult; D002585:Cesarean Section / Q000191:economics*; D036861:Delivery, Obstetric / Q000191:economics*; D005191:Family Characteristics; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006771:Hospitals, Maternity / Q000191:economics*; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D009390:Nepal; D049590:Postpartum Period; D011247:Pregnancy; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers