Payment mechanism for institutional births in Nepal

Area of Science:

• Public Health
• Health Economics
• Maternal Health

Background:

• Efforts to increase institutional births via demand-side financing have been ongoing since the Millennium Development Goal era.
• Nepal's government implemented the Maternity Incentive Scheme (MIS) in 2005 to decrease out-of-pocket expenditure (OOPE) for institutional births.
• This study assesses OOPE for institutional births and MIS coverage in Nepal.

Purpose of the Study:

• To evaluate the out-of-pocket expenditure (OOPE) incurred by women for institutional births in Nepal.
• To determine the coverage and effectiveness of the Maternity Incentive Scheme (MIS) in reducing these costs.
• To identify factors influencing OOPE, such as mode of delivery and duration of hospital stay.

Main Methods:

• A prospective cohort study was conducted over 18 months in 12 Nepalese hospitals.
• Data were collected through pre-discharge interviews with 21,697 women regarding medical and non-medical service costs.
• Out-of-pocket expenditure was analyzed by mode of delivery, duration of stay, and hospital, alongside MIS coverage.

Main Results:

• The average OOPE per birth was 41.5 USD, with 36% attributed to transportation costs.
• Median OOPE varied significantly by hospital, mode of delivery (higher for Cesarean births), and duration of stay.
• Maternity Incentive Scheme (MIS) coverage was high, reaching 96.5% among enrolled women.

Conclusions:

• Families continue to face substantial out-of-pocket expenditure for institutional births, with hospital care being a major component.
• OOPE is influenced by the duration of hospital stay and the mode of birth (vaginal vs. Cesarean).
• Given the near-universal MIS coverage, reimbursement amounts should be reviewed in relation to duration of stay and mode of birth to better alleviate financial burdens.