title: Out of pocket expenditure to deliver at public health facilities in India: a cross sectional analysis.
abstract: BACKGROUND
  To expand access to safe deliveries, some developing countries have initiated demand-side financing schemes promoting institutional delivery. In the context of conditional cash incentive scheme and free maternity care in public health facilities in India, studies have highlighted high out of pocket expenditure (OOPE) of Indian families for delivery and maternity care. In this context the study assesses the components of OOPE that women incurred while accessing maternity care in public health facilities in Uttar Pradesh, India. It also assesses the determinants of OOPE and the level of maternal satisfaction while accessing care from these facilities.
  
  
  METHODS
  It is a cross-sectional analysis of 558 recently delivered women who have delivered at four public health facilities in Uttar Pradesh, India. All OOPE related information was collected through interviews using structured pre-tested questionnaires. Frequencies, Mann-Whitney test and categorical regression were used for data reduction.
  
  
  RESULTS
  The analysis showed that the median OOPE was INR 700 (US$ 11.48) which varied between INR 680 (US$ 11.15) for normal delivery and INR 970 (US$ 15.9) for complicated cases. Tips for getting services (consisting of gifts and tips for services) with a median value of INR 320 (US$ 5.25) contributed to the major share in OOPE. Women from households with income more than INR 4000 (US$ 65.57) per month, general castes, primi-gravida, complicated delivery and those not accompanied by community health workers incurred higher OOPE. The significant predictors for high OOPE were caste (General Vs. OBC, SC/ST), type of delivery (Complicated Vs. Normal), and presence of ASHA (No Vs. Yes). OOPE while accessing care for delivery was one among the least satisfactory items and 76 % women expressed their dissatisfaction.
  
  
  CONCLUSIONS
  Even though services at the public health facilities in India are supposed to be provided free of cost, it is actually not free, and the women in this study paid almost half of their mandated cash incentives to obtain delivery care.
authors.affiliation: Public Health Foundation of India, Plot no. 47, Sector 44 Institutional Area, Gurgaon, 122002, Haryana, India.
authors.forename: Anns
authors.initials: A
authors.lastname: Issac
authors.affiliation: Public Health Foundation of India, Plot no. 47, Sector 44 Institutional Area, Gurgaon, 122002, Haryana, India.
authors.forename: Susmita
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Public Health Foundation of India, Plot no. 47, Sector 44 Institutional Area, Gurgaon, 122002, Haryana, India.
authors.forename: Aradhana
authors.initials: A
authors.lastname: Srivastava
authors.affiliation: Public Health Foundation of India, Plot no. 47, Sector 44 Institutional Area, Gurgaon, 122002, Haryana, India. sanghita@phfi.org.
authors.forename: Sanghita
authors.initials: S
authors.lastname: Bhattacharyya
mesh_terms: D000328:Adult; D003258:Consumer Behavior; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000191:economics* / Q000379:methods / Q000592:standards; D003906:Developing Countries; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000191:economics* / Q000592:standards; D011634:Public Health / Q000191:economics* / Q000592:standards; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Delivery care; India; Out of pocket expenditure; Public health facilities; Tips for getting services