IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0208299.html
   My bibliography  Save this article

A comparison of maternal and newborn health services costs in Sindh Pakistan

Author

Listed:
  • Asif Raza Khowaja
  • Craig Mitton
  • Rahat Qureshi
  • Stirling Bryan
  • Laura A Magee
  • Peter von Dadelszen
  • Zulfiqar A Bhutta

Abstract

Pakistani women suffer the highest rate of maternal mortality in South Asia. A lack of comprehensive knowledge about maternal and newborn health (MNH) services costs impedes policy decisions to maximize the benefit from existing, as well as emerging, MNH interventions in Pakistan. We compared MNH service costs at different levels of care. A cross-sectional survey was conducted during January to March 2016 as part of a large economic evaluation in Sindh, Pakistan. Health providers and facilities were selected from a sampling frame, inclusive of public and private sectors. This study utilized a broad perspective (i.e. costs to the health system and patients/families). The unit costs of MNH services were determined through a simultaneous allocation method in the public facilities; and patient billing department in the private facilities. Descriptive analysis was performed, and an analysis of variance (ANOVA) test was applied to compare overall mean costs both within and between health facilities. A total of 31 eligible health providers and facilities (n = 25 in private; n = 7 in public) were included in the final analysis. An ambulatory visit (AV) for routine antenatal care (ANC) costs $3.6 and $0.9 at secondary- and tertiary-level public facilities, respectively. In the private sector, the costs of an AV for ANC were slightly less ($2.8) at secondary-level and much higher ($6) at tertiary-level facilities compared to the public sector. Diagnostic test costs were much higher in private facilities. The average costs of inpatient admissions were $30.5 at general ward (GW), and $151 at the intensive care unit (ICU) in public facilities. In-patient admissions costs were lower such as $9.3 at GW and $36.5 at ICU in private facilities. Understanding cost is critical to guide decisions of resource allocation within the public sector; and risk mitigation for excessive OOP costs through third party payer for services in the private sector.

Suggested Citation

  • Asif Raza Khowaja & Craig Mitton & Rahat Qureshi & Stirling Bryan & Laura A Magee & Peter von Dadelszen & Zulfiqar A Bhutta, 2018. "A comparison of maternal and newborn health services costs in Sindh Pakistan," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-11, December.
  • Handle: RePEc:plo:pone00:0208299
    DOI: 10.1371/journal.pone.0208299
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208299
    Download Restriction: no

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208299&type=printable
    Download Restriction: no

    File URL: https://libkey.io/10.1371/journal.pone.0208299?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Owen O'Donnell & Eddy van Doorslaer & Ravi P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Deni Harbianto & Charu C. Garg & Piya Hanvoravongchai & Mohammed N. Huq & Anup Karan & Gabriel M., 2007. "The Incidence of Public Spending on Healthcare: Comparative Evidence from Asia," The World Bank Economic Review, World Bank, vol. 21(1), pages 93-123.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Aiza Sarwar, 2021. "Mapping out regional disparities of reproductive health care services (RHCS) across Pakistan: an exploratory spatial approach," Asia-Pacific Journal of Regional Science, Springer, vol. 5(3), pages 825-849, October.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. World Bank, 2008. "Sri Lanka : Addressing the Needs of an Aging Population," World Bank Publications - Reports 8105, The World Bank Group.
    2. Mingsheng Chen & Yuxin Zhao & Lei Si, 2014. "Who Pays for Health Care in China? The Case of Heilongjiang Province," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-11, October.
    3. Anselmi, Laura & Lagarde, Mylène & Hanson, Kara, 2015. "Going beyond horizontal equity: An analysis of health expenditure allocation across geographic areas in Mozambique," Social Science & Medicine, Elsevier, vol. 130(C), pages 216-224.
    4. Biplab Dhak, 2015. "Demographic Change and Catastrophic Health Expenditure in India," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 122(3), pages 723-733, July.
    5. Wang, Xinfeng & Ye, Xin, 2024. "Impact of the targeted poverty alleviation policy on older adults’ healthcare utilization: A quasi-experimental analysis from China," Social Science & Medicine, Elsevier, vol. 356(C).
    6. Robone, S & Rice, N & Smith, P, 2010. "Health systems’ responsiveness and its characteristics: a cross-country comparative analysis," Health, Econometrics and Data Group (HEDG) Working Papers 10/29, HEDG, c/o Department of Economics, University of York.
    7. Eddy van Doorslaer & Owen O'Donnell, 2008. "Measurement and Explanation of Inequality in Health and Health Care in Low-Income Settings," WIDER Working Paper Series DP2008-04, World Institute for Development Economic Research (UNU-WIDER).
    8. repec:jet:dpaper:dpaper391 is not listed on IDEAS
    9. Adam Wagstaff & Winnie Yip & Magnus Lindelow & William C. Hsiao, 2009. "China's health system and its reform: a review of recent studies," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 7-23, July.
    10. Mundle, Sudipto, 2018. "Development of Education and Health Services in Asia and the Role of the State," Working Papers 18/239, National Institute of Public Finance and Policy.
    11. Parmar, Divya & Banerjee, Aneesh, 2019. "How do supply- and demand-side interventions influence equity in healthcare utilisation? Evidence from maternal healthcare in Senegal," Social Science & Medicine, Elsevier, vol. 241(C).
    12. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    13. Uzochukwu Amakom, 2016. "Nigeria’s Government Spending on Basic Education and Healthcare in the Last Decade: What has Changed After Reforms?," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 127(3), pages 1085-1102, July.
    14. Jeannette Amaya Lara & Fernando Ruiz Gómez, 2011. "Determining factors of catastrophic health spending in Bogota, Colombia," International Journal of Health Economics and Management, Springer, vol. 11(2), pages 83-100, June.
    15. Samuel S. Lieberman & Adam Wagstaff, 2009. "Health Financing and Delivery in Vietnam : Looking Forward," World Bank Publications - Books, The World Bank Group, number 2594, April.
    16. Channon, Andrew Amos & Andrade, Monica Viegas & Noronha, Kenya & Leone, Tiziana & Dilip, T.R., 2012. "Inpatient care of the elderly in Brazil and India: Assessing social inequalities," Social Science & Medicine, Elsevier, vol. 75(12), pages 2394-2402.
    17. Ahmed Shoukry Rashad & Mesbah Fathy Sharaf, 2015. "Who Benefits from Public Healthcare Subsidies in Egypt?," Social Sciences, MDPI, vol. 4(4), pages 1-15, November.
    18. O'Donnell, Owen & van Doorslaer, Eddy & Rannan-Eliya, Ravi P. & Somanathan, Aparnaa & Adhikari, Shiva Raj & Akkazieva, Baktygul & Harbianto, Deni & Garg, Charu C. & Hanvoravongchai, Piya & Herrin, Ale, 2008. "Who pays for health care in Asia?," Journal of Health Economics, Elsevier, vol. 27(2), pages 460-475, March.
    19. Wagstaff, Adam & Bilger, Marcel & Buisman, Leander R. & Bredenkamp, Caryn, 2014. "Who benefits from government health spending and why? a global assessment," Policy Research Working Paper Series 7044, The World Bank.
    20. Sudipto Mundle, 2018. "Fifty years of Asian experience in the spread of education and healthcare," WIDER Working Paper Series wp-2018-97, World Institute for Development Economic Research (UNU-WIDER).
    21. Van de Poel, Ellen & Van Doorslaer, Eddy & O’Donnell, Owen, 2012. "Measurement of inequity in health care with heterogeneous response of use to need," Journal of Health Economics, Elsevier, vol. 31(4), pages 676-689.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0208299. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.