Hidden Costs of Institutional Delivery and Associated Factors in Bale Zone Public Hospitals, Oromia Region, Southeast of Ethiopia.

Abstract

Background: Reduction of maternal mortality is one of the priority goals on the international agenda like Sustainable Development Goal and others. For attainment of maternal mortality reduction goal several interventions were applied in Ethiopia. Of which, decreasing barriers of maternal health service including institutional delivery for free is implemented. However, the hidden cost of institutional delivery which retracts the poor households from using the service is not official accounted in hospital cost to devise policy implication for enhancing national coverage of institutional delivery. Objective: To estimate the hidden costs of institutional delivery and associated factors in Public Hospitals of Bale Zone,2018. Methods: Institutional based cross sectional study design was employed from august 13 to September 9, 2018.The data were collected through structure questionnaire & face to face exist interview was employed., Bottom-up and Human capital approaches method were used to estimate the cost. The consecutive sampling technique was used to select the study participants. Multiple linear regression analysis was done to identify significant predictors. Significant independent predictors were declared at 95% confidence level & P-value less than 0.05. Result: Out of the total 390 mothers who were planned for the study 390 were successfully interviewed, yielding the response rate of 100%. The total median of non-medical cost was 14US$[95% CI: $13-15], the median of direct medical cost of drug expenses from private pharmacy 4.7UD$[95% CI:3.7$-5.7$] and the median of indirect cost was 9.7US$[95% CI:8.7$-10.6$] respectively. The median of total hidden costs expenditure was 25.5US$[95% CI:23.8$-27$], indicating that in median patient expenditure was equivalent to 2% of annual family income. Distance from the hospital[P=0.0001], length of stay in hospital[P=0.0001], mode of delivery [Instrumental, P=0.003, Caesarean section P=0.037], family monthly income[P=0.0001] were significantly associated with hidden cost. The adjusted R2 value for this model was 53.6%. Conclusion: The finding of the study suggested that, the half percent of the mothers were incurred high total hidden cost. Direct cost of drug expenses from private pharmacy was low percent accounted from the total hidden cost. Length of stay, mode of delivery, family monthly income, and distance were significantly associated with the hidden cost institutional delivery.