Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112561

Suhaila H. Khan, Tulane School of Public Health & Tropical Medicine, Department of International Health & Development, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, 504-988-1348, skhan3@tulane.edu

Objective: This study investigated the types and amount of out-of-pocket expenditures by patients, the factors influencing these expenses and the impact of these expenses on household income.

Method: Eighty-one maternity patients were interviewed during their hospitalization in the Dhaka Medical College Hospital with a semi-structured in-depth questionnaire. Patients were selected by quota sample.

Results: All patients incurred substantial out-of-pocket expenditures for travel, hospital admission fees, medicine, tests, food, and tips. The median total per-patient expenditure was $65 (range $2-$350), equivalent to 7% (range 0.04%-225%) of annual household income. Half of all patients reported that they had borrowed to pay for care at interest rates of 5%-30% per month. A third of these patients reported selling jewelry, land or household items to moneylenders. The rural patients reported more difficulty in paying for care than the urban patients. Duration of hospitalization, rural residence, and necessary (e.g. C-section, hysterectomy) and unnecessary (e.g. episiotomy) medical procedures increased the expenditures.

Conclusion: Public maternity services in Bangladesh impose large out-of-pocket expenditures on patients. Authorities could reduce the burden by reducing the duration of hospital stays, limiting use of medical procedures, eliminating tips, and moving routine services closer to potential users. Fee for service could reduce unofficial expenditures if the fee were lower than and replaced typical unofficial expenditures. Otherwise adding service fees without reform of current public hospital practices would lead to even more burdensome expenditures and inequities.

Learning Objectives:

• After this presentation participants will get an idea of the magnitude of the patient expenditures in a developing country context, which is big. Also, participants will get an idea/information about the magnitude of the impoverishing effects of these maternity expenditures. This study is aiming to educate both medical practitioners and policy-makers about where feasible cost cutting is possible.

Keywords: Healthcare Costs, International Health

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.