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Indian Journal of Community Medicine

Cost Factors Related with Normal Vaginal Delivery and Caesarean Section in Government and Non-Government Settings

Author(s): D.M. Satapathy1, R. Panda1, B.C. Das2

Vol. 30, No. 2 (2005-04 - 2005-06)

Abstract

Research question: 1. What is the amount of money incurred in caesaran section normal veginal delivery (N.V.D.) in government & private hospitals?. 2. How these costs can be met by the common man? Objectives: 1. To estimate the cost factors involved in caesarean section (C.S.) and normal vaginal delivery (N.V.D.) in various government and private settings. 2. To analyse the comparative economic burden for each type of cases in various settings and suggest measures as to how to make them affordable. Design: Cross-Sectional Study. Settings: Private and Government Hospitals. Participants: Delivery cases in both private and government settings. Statistical Analysis: Proportions, Z-test. Result: Cost per C.S. in government and private settings were Rs. 7012+628 and 9660 +342.8. This difference was highly significant (Z=55.90; p<0.001). The total cost of normal vaginal delivery was Rs. 8215+433 and Rs. 6187+307.7 in govenment and private secotors and this difference was significant. Health insurance with subsidies from both govenment and private bodies is the solution to meet this econmical burden.

Key Words: Caesarean Section, Normal Vaginal Delivery, Cost Unit, Health Insurance.

Introduction:

Health can not be isolated form its social context. The last few decades have shown the social and economic factors have as much effect on health as medical interventions. In India, women of the childbearing period (15-44 years) constitute nearly 19% of the population and by virtue of their sheer number they are one of the major consumers of health service of whatever form1.

Normal delivery, a simple and effective procedure in the process of child birth is slowly being edged out by the more prohibitive caesarean section (CS), for various reasons, making a joyous human event into a cause for much concern.

The city of Berhampur in southern Orissa a bustling business centre has a population of 5 lakhs approximately. Well served by a host of private and government hospitals and maternity homes, the people have access to health care facilities, although the prohibitive costs are a major deterrent.

Cost analysis can be an important element in setting levels of user fees2. A number of developing countries are considering or are starting to implement systems of national health insurance. Unit cost analysis allows an appropriate rate of payment to be developed3. In countires which allow multiple insurance to emerge; there is some risk that each insurer will try to pay less than its share of the hospital overhead.

Measuring unit costs can help sort out these issues by distinguishing direct costs of an admission4.

A comparative cost analysis study was undertaken in the Department of S.P.M., M.K.C.G. Medical College to find out the average cost of normal deliveries and C.S. and the difference in cost in both private and public setting with objectives, (1 ) To estimate the cost factors involved in C.S. and normal vaginal delivery in various Govt. and Non-Govt. settings, (2) To analyse the comparative economical burden for each type of cases in various settings.

Materials and Methods:

The study was carried out between 1.12.2000 to 28.2.2001 in different government hospitals and private nursing homes of Berhampur City. About 650 cases who had delivered either by N.V.D. or C.S. were interviewed by pretested scientific schedule. Information regarding expenditure before and after delivery which includes cost of medicine, hospital stay cost, loss of wages, transport cost etc. were collected from the cases directly by interview technique. Separate costs for normal vaginal delivery and delivery by C.S. were calculated for hospital delivery and delivery at nursing homes. The costs involved for different method of delivery and different places were than compared by using the Z-test.

Results:

Total numbers of cases were 650 out of which normal vaginal deliveries was 61.5% and C.S. 39.4%. More C.S. cases were concentrated in the private sector. There was very slight difference between the money spent on drugs in both N.V.D. and C.S. between the government and private sectors, because drugs were not subsidized ever by the government hospitals. However, there was substantial difference between government and private settings as far as hospital stay was concerned. This included accommodation, food and other expenses. Total cost of the normal vaginal delivery was Rs. 3215 + 433 and Rs. 6187 + 307.7 in government and private sectors and the difference between the mean of the two expenditures was also significant (Z = 17.7, P < 0.001), Total cost per C.S. in government and private settings was Rs. 7012 + Rs. 628 and Rs. 19660 + 342.8 (Table-I). The average cost of N.V.D. came to be Rs. 5051 and that of C.S. Rs. 13836, regardless of place of delivery.

Table I - Cost Factors Involved in NVD and CS in Government and Private Setting

Place of Delivery
  Government Hospital Private Hospital
Expenditure NVD
(n=270)
CS
(n=100)
NVD
(n=130)
CS
(n=150)
A) Expenditure before Delivery
Investigation 1700 3100 1900 3400
Other costs 800 200 1100 2200
Total 2500 5100 3000 5600
B) Expenditure after delivery
Hospital Stay* 650 1800 4300 11000
Loss of Income 250 1000 400 1800
Transport 1300 700 600 1000
Total 1200 3500 5300 13800
Grand Total (A+B) 3700 8600 8300 19400
*Includes drugs and perks to Class-IV employees in Govt. setting drugs,
delivery room/OT Charges, room rent etc. in Private settings.

Discussion:

The WHO in its Alma Ata declaration had recommended that public health care expenditures should be at least 5% of GDP, if equality and universal coverage are to be realised5. In India, 1.5% of GDP is spent on health and family welfare which includes health expenditures by municipal bodies. At the state levels, departments of health are spending around 5% of the total government expenditure, plan and non-plan of revenue account on medical and public health programme6. In both the developing and developed countries, hospitals are seen as vital and necessary community resources that should be managed for the benefit of the community7. Cost analysis can be an important element in setting levels of user fees, although in practice fee setting is also guided by other considerations. Government's can and often should, continue to subsidized care at public hospitals.

Nevertheless the calculation of unit allows that subsidy to be allocated more rationally. In this particular study for instance, the observation that if drugs for delivery would have been subsidized in Government settings it would have dramatically brought down cost. Such studies on various diseases can go a long way in improving the allocation of scarce resources appropriately.

Conclusion:

Regardless of the place of delivery, the costs of normal vaginal delivery an creation such in are far beyond the limits of an average middle class family in India and such a study has raised so many important issues, which are to be addressed as a part of health economics. More such studies have to be done on various other diseases and effective premiums suggested. Health insurance has come to say and it seems an effective way to bright about affordability for health services to the vast middle class.

References:

  1. Govt. of India (2000). Annual Report, 1999-200, Ministry of Health & Family Welfare.
  2. Shepard D et al. Cost Effectiveness of Ambulatory Surgery in Columbia Health Policy and Planning. A Procedure for Projecting Hospital Recurring Cost, 8(2); 136-142.
  3. Barrum H. Kutzin (1993). Public Hospitals in Developing Coutries: Resource, Use, Cost, Financing. John Hopkins University Press.
  4. Ma McMC Guire & McGuire. Analysis of Hospital Costs: A Manual for Managers. Institute for Health Policy, Heller Graduate School, Bradels University, USA.
  5. UNDP (1990 and 1992). Human Development Report, Oxford University Press.
  6. Government of India (Ministry for Finance), 1992. Indian Economic Statistics Public Finance.
  7. Van Lerberghe & Lafort, 1990. Institute for Health Policy Studies.

1Dept. of S.P.M., M.K.C.G. Medical College, Berhampur, Orissa.
2Director of State Institute, Health and Family Welfare Department, Govt. of Orissa.

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