Correlates of Distress Financing In Case of Institutional Delivery In India: Evidence From The National Family Health Survey

Bhattacharyya, Bhaskar and Mandal, Biswajit and Sengupta, Sarbajit (2022): Correlates of Distress Financing In Case of Institutional Delivery In India: Evidence From The National Family Health Survey.

Abstract

Using data from NFHS-4, this study examines the progressiveness of out-of-pocket spending and health financing methods used in the case of institutional delivery in India. We used concentration indices to arrive at some intriguing results. Applying Multinomial Logit Model we focus on how various socio-economic factors play crucial role in making choice among alternative distress financing options. Unlike other studies, we find that as women get older, they often arrange for money by selling jewelries for health purpose. This is equally true for women with a secondary education. They also rely on other strategies like saving and selling. In case of different social division in Indian society, the SCs and the OBCs are found to be more susceptible to distress financing. In spite of some government initiatives like Janani Suraksha Yojana (JSY) the problem of out- of- pocket expenditure related distress has not been reduced substantially. In our opinion this is a policy failure. In order to address this problem a concerted effort from both demand and supply side should be made available.

• Item Type: MPRA Paper
• Language: English
• Keywords: Out- of- pocket expenditure, distress financing, institutional delivery
• Subjects: I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior; I - Health, Education, and Welfare > I1 - Health > I13 - Health Insurance, Public and Private; I - Health, Education, and Welfare > I1 - Health > I14 - Health and Inequality; I - Health, Education, and Welfare > I1 - Health > I15 - Health and Economic Development; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health

References

Agresti. (2002). Categorical Data Analysis, Second Edition. Wiley Series in Probability and Statistics Ali, B., Dhillon, P., & Mohanty, S. K. (2019): Inequalities in the utilization of maternal health care in the pre-and post-National Health Mission periods in India. J Biosoc Sci, 52(2), pp 198-212. Alvarez, R. M., and Nagler, J. (1998). When politics and models collide: Estimating models of multiparty elections. American Journal of Political Science, 55-96. Alvarez, R. M., Nagler, J., and Bowler, S. (2000). Issues, economics, and the dynamics of multiparty elections: The British 1987 general election. American Political Science Review, 94(1), pp. 131-149. Banerjee, A., Deaton, A., & Duflo, E. (2004): Wealth, health, and health services in rural Rajasthan. American Economic Review, 94(2), pp 326-330. Basic Concepts of Multinomial Logistic Regression. from https://www.real-statistics.com/multinomial-ordinal-logistic-regression/basic-concepts-of-multinomial-logistic-regression-basic-concept/ (accessed August, 2021) Basumatary, J., & Srivastav, N.(2018): Household’s Coping Mechanisms of Out-of-Pocket Expenditure on Health Care: a Case Study of Assam, India. IOSR Journal of Humanitiesand Social Science, 23(1), version 9, pp 70- 84. Bel, K., and Paap, R. (2014). A multivariate model for multinomial choices (No. EI 2014-26). Bhatia, J. C. and Cleland, J. (1995). Determinants of maternal care in a region of South India. Health Transition Review, Vol. 5, pp. 127- 142. Borghi, J., Ensor, T., Neupane, B. D., and Tiwari, S. (2004). Coping with the burden of the costs of maternal health. Nepal Safer Mother Proj Part HMGN Safe Mother Programme Publ Place Publ. Category of Social groups in India, accessed from https://en.wikipedia.org/wiki/Category:Social_groups_of_India Daivadanam, M., Thankappan, K. R., Sarma, P. S., & Harikrishnan, S. (2012): Catastrophic health expenditure & coping strategies associated with acute coronary syndrome in Kerala, India. The Indian journal of medical research, 136(4), pp 585- 592. Damme, W. V., Leemput, L. V., Por, I., Hardeman, W., & Meessen, B. (2004): Out‐of‐pocket health expenditure and debt in poor households: evidence from Cambodia. Tropical Medicine & International Health, 9(2), pp 273-280. de la Santé, O. M. (2010). Health System Financing. The Path to Universal Coverage. en ligne: http://www. who. int/whr/2010/whr10_en. pdf. Devadasan, N., Elias, M. A., John, D., Grahacharya, S., & Ralte, L. (2008): A conditional cash assistance programme for promoting institutional deliveries among the poor in India: process evaluation results. Reducing financial barriers to obstetric care in low-income countries. Studies in HSO&P, pp 257- 273 Dow, J. K., & Endersby, J. W. (2004): Multinomial probit and multinomial logit: a comparison of choice models for voting research. Electoral studies, 23(1), pp 107-122. Garg, C. C., & Karan, A. K. (2009): Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India. Health policy and planning, 24(2), pp 116-128. Hoffman, S. D., and Duncan, G. J. (1988). A comparison of choice-based multinomial and nested logit models: the family structure and welfare use decisions of divorced or separated women. The Journal of Human Resources, 23(4), pp. 550-562. Hoque, M. E., Dasgupta, S. K., Naznin, E., and Al Mamun, A. (2015). Household coping strategies for delivery and related healthcare cost: findings from rural Bangladesh. Tropical Medicine and International Health, 20(10), 1368-1375. International Institute of Population Sciences (2020), ‘State-level Fact Sheets on NFHS-5 2019-20’ Issac, A., Chatterjee, S., Srivastava, A., & Bhattacharyya, S. (2016): Out of pocket expenditure to deliver at public health facilities in India: a cross sectional analysis. Reproductive health, 13(1), pp 1-9. Joe, W. (2015): Distressed financing of household out-of-pocket health care payments in India: incidence and correlates. Health policy and planning, 30(6), pp 728-741. John, D., & Kumar, V. (2017): Exposure to hardship financing for healthcare among rural poor in Chhattisgarh, India. Journal of Health Management, 19(3), pp 387-400. Jones, S., and Hensher, D. A. (2004). Predicting firm financial distress: A mixed logit model. The accounting review, 79(4), 1011-1038. Karan, A., Engelgau, M., & Mahal, A. (2014): The household‐level economic burden of heart disease in I ndia. Tropical Medicine & International Health, 19(5), pp 581-591. Kastor, A., and Mohanty, S. K. (2018): Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: do Indian households face distress health financing?. PloS one, 13(5), p.e0196106. Kropko, J. (2008). Choosing between multinomial logit and multinomial probit models for analysis of unordered choice data (Doctoral dissertation, The University of North Carolina at Chapel Hill). Mauro, P. (1998). Corruption and the composition of government expenditure. Journal of Public economics, 69(2), 263-279.McIntyre et al. 2006 Mavalankar, D., Vora, K., and Prakasamma, M. (2008). Achieving millennium development goal 5: is India serious?. Bulletin of World HealthOrganisation, 86(4), 243-244. McCullagh, P. (1980). Regression models for ordinal data. Journal of the Royal Statistical Society: Series B (Methodological), 42(2), pp. 109-127. Mishra, P.S. and Shyamala, T.S.(2021). The escalating financial burden of child births. Ideas for India Mishra, S., & Mohanty, S. K. (2019): Out-of-pocket expenditure and distress financing on institutional delivery in India. International journal for equity in health, 18(1), pp 1- 15. Mohanty, S. K., & Kastor, A. (2017): Out-of-pocket expenditure and catastrophic health spending on maternal care in public and private health centres in India: a comparative study of pre and post national health mission period. Health economics review, 7(1), pp 1- 15. Mohanty, S. K., & Srivastava, A. (2013): Out-of-pocket expenditure on institutional delivery in India. Health policy and planning, 28(3), pp 247-262. Mohanty, S. K., and Srivastava, A. (2013). Cost and utilisation of hospital based delivery care in empowered action group (EAG) states of India. Maternal and child health journal, 17(8), 1441-1451. Mohanty, S. K., Panda, B. K., Khan, P. K., & Behera, P. (2019): Out-of-pocket expenditure and correlates of caesarean births in public and private health centres in India. Social Science & Medicine, 224, pp 45-57. Mukherjee, S., and Singh, A. (2018). Has the Janani Suraksha Yojana (a conditional maternity benefit transfer scheme) succeeded in reducing the economic burden of maternity in rural India? Evidence from the Varanasi district of Uttar Pradesh. Journal of public health research, 7(1). Mukherjee, S., Singh, A., and Chandra, R. (2013). Maternity or catastrophe: a study of household expenditure on maternal health care in India. Multinomial Logit Models- Overview, by Richard Williams (2021). from https://www3.nd.edu/~rwilliam/stats3/Mlogit1.pdf (accessed August, 2021) Nahar, S., & Costello, A. (1998): The hidden cost of ‘free’maternity care in Dhaka, Bangladesh. Health policy and planning, 13(4), pp 417-422. Navaneetham, K., and Dharmalingam, A. (2002). Utilization of maternal health care services in Southern India. Social science and medicine, 55(10), 1849-1869. NFHS- 4 India Report from http://rchiips.org/nfhs/pdf/nfhs4/india.pdf (Accessed February 1, 2020) Ordinal logistic regression| An overview and implementation in R, by Akanksha Rawat (2018). from https://towardsdatascience.com/implementing-and-interpreting-ordinal-logistic-regression-1ee699274cf5 (accessed August, 2021) Pandey, P., Singh, S. K., & Mohan, U. (2016): Prevalence of distressed financing among elderly in a North Indian district. Community & Family Medicine, 2(02), pp 48- 52. Peel, A., Bhartia, A., Spicer, N., and Gautham, M. (2018). ‘If I do 10–15 normal deliveries in a month I hardly ever sleep at home.’A qualitative study of health providers’ reasons for high rates of caesarean deliveries in private sector maternity care in Delhi, India. BMC pregnancy and childbirth, 18(1), 1-11. Rahman, M. M., & Pallikadavath, S. (2018): How much do conditional cash transfers increase the utilization of maternal and child health care services? New evidence from Janani Suraksha Yojana in India. Economics & Human Biology, 31, pp 164-183. Rahman, M. M., Gilmour, S., Saito, E., Sultana, P., & Shibuya, K. (2013): Self-reported illness and household strategies for coping with health-care payments in Bangladesh. Bulletin of the World Health Organization, 91, pp 449-458. Sauerborn, R., Adams, A., & Hien, M. (1996): Household strategies to cope with the economic costs of illness. Social science & medicine, 43(3), pp 291-301. Sengupta, N., & Sinha, A. (2018): Is India’s Safe Motherhood Scheme Leading to Better Child Health Care Practices?. Global Social Welfare, 5(1), pp 49-58. Skarbinski, J., Walker, H. K., Baker, L. C., Kobaladze, A., Kirtava, Z., & Raffin, T. A. (2002): The burden of out-of-pocket payments for health care in Tbilisi, Republic of Georgia. Jama, 287(8), pp 1043-1049. Skordis- Worrall, J., Pace, N., Bapat, U., Das, S., More, N. S., Joshi, W., Pulkki- Brannstrom, AM & Osrin, D. (2011): Maternal and neonatal health expenditure in Mumbai slums (India): A cross sectional study. BMC Public Health, 11 (1), pp 1- 12. Tahsina, T., Ali, N. B., Siddique, M. A. B., Ahmed, S., Rahman, M., Islam, S., ... & Arifeen, S. E. (2018): Determinants of hardship financing in coping with out of pocket payment for care seeking of under five children in selected rural areas of Bangladesh. PloS one, 13(5), p.e0196237. UN. Final list of proposed Sustainable Development Goal indicators. Rep Inter-Agency Expert Gr Sustain Dev Goal Indic [Internet]. 2015;Annex IV.Available from: https://sustainabledevelopment.un.org/content/documents/11803Official-List-of-Proposed-SDG-Indicators.pdf Unit level data for NFHS- 4 accessed from DHS website https://www.dhsprogram.com/data/dataset/India_Standard-DHS_2015.cfm?flag=0 (on April1, 2020) Wagstaff, A., Paci, P., & Van Doorslaer, E. (1991): On the measurement of inequalities in health. Social science & medicine, 33(5), pp 545-557. Yadav, J., John, D., Menon, G. R., and Allarakha, S. (2021). Out-of-Pocket Payments for Delivery Care in India: Do Households face Hardship Financing?. Journal of Health Management, 23(2), 197-225.