Out-of-pocket spending on public and private antenatal care among women delivering at a tertiary care centre in northern Sri Lanka

Abstract

Background and objective: Pregnant women who access public healthcare also use private ANC. This study describes out-of-pocket expenses (OOPE) on public and private antenatal care and associated factors among pregnant women delivering at Teaching Hospital Jaffna (THJ). Methods: This descriptive cross-sectional study was conducted at THJ. Pregnant women ≥18 years awaiting delivery after completing 33 weeks of gestation were consecutively recruited. An interviewer-administered questionnaire elicited data on sociodemographic details and OOPE. Data were collected over 12 weeks (20/06/2022 to 09/09/2022). Interviews were held at the bedside and medical records reviewed. Data were analysed with SPSS (v21). Total OOPE data were log-transformed and multiple linear regression was used to analyse predictors (critical level 0.05). Results: In total, 251 pregnant women participated (response rate 97.6%). In the sample, 199 (79.3%) women were unemployed homemakers and 209 (83.2%) reported a monthly household income of ≤Rs. 50,000. Antenatal risk factors were documented in the H-512 in 183 (72.9%) participants. The majority reported using private ANC (80.5%, n=202), mostly private pharmacies (60.6%), specialist consultations (48.2%), and private diagnostic services (45%). Mean total OOPE on ANC was Rs.17,304 (SD 25,169) with a median of Rs. 6,049 (IQR 1,984-26,315). Among those who reported using the relevant service component, highest spending was on ultrasound scanning [mean Rs. 8,698 (SD 5,693); median Rs. 8,250 (IQR 3,850-11,900)], specialist consultations [mean Rs. 7364 (SD 4,586); median Rs. 7,800 (IQR 2,650-11,450)] and pharmaceuticals [mean Rs. 6,678 (SD 17,528); median Rs. 1,400 (IQR 300-6,000)]. Monthly household income, number of antenatal risk factors, and visiting channeling centres were identified as significant predictors of OOPE (R2=0.63; F=113.64, df=3, p<0.001). Conclusions: Pregnant women who rely on the public sector in Jaffna report substantial levels of OOPE, with over half the sample having spent over Rs. 6000 on ANC in the post-COVID setting. Wealthier women, those with several antenatal risk factors, and those who accessed private specialist care were more likely to spend out-of-pocket on ANC.