Distress Financing for Institutional Delivery in India: A Regional Analysis of Economic Inequality, Coping Mechanisms, and Contributing Factors

IF 1.8 4区医学 Q3 HEALTH POLICY & SERVICES

International Journal of Health Planning and Management Pub Date : 2025-06-07 DOI:10.1002/hpm.3950

Puja Pal, Md. Juel Rana

{"title":"Distress Financing for Institutional Delivery in India: A Regional Analysis of Economic Inequality, Coping Mechanisms, and Contributing Factors","authors":"Puja Pal, Md. Juel Rana","doi":"10.1002/hpm.3950","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Financial hardship is among the significant challenges in the utilization of maternal healthcare services in India. It is further aggravated by the issue of inequality in the distress financing (DF) for institutional delivery (ID) which pushes the poor into a vicious cycle of poverty. The paper examines the pattern of inequality and regional variation in DF for ID in India. It also determines the factor contributing to the inequality in the DF for ID among a few selected states.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>The paper uses unit-level data from the fifth National Family Health Survey (NFHS-5) round conducted during 2019-21. The concentration curve (CC) and concentration index (CI) capture the inequalities in DF for ID. Also, the decomposition analysis of CI was performed to capture the contribution of key determinants in explaining the inequality in DF for ID.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The study reveals that 16.3% of women in India incurred DF for ID, with the poorest quintile facing the highest burden (21.2%). Significant regional variations exist, with states like Telangana (30%) and Manipur (29.9%) showing the highest DF rates. Borrowing is the primary coping mechanism, particularly among the poorest. The concentration index (CI) analysis indicates that DF dominates among poorer women across states. Decomposition analysis highlights wealth status and education as the major contributors to inequality in DF, with significant regional disparities.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Addressing DF for ID requires strengthening maternity benefit schemes like Janani Suraksha Yojana (JSY) to cover indirect costs and ensure timely disbursements while curbing informal charges. Reducing out-of-pocket expenditure (OOPE) through improving accessibility and quality of public hospitals and regulation of private facility fees is essential. Alongside, expanding health insurance for comprehensive maternity care is essential, particularly in high-inequality states like Telangana, Kerala, and Tamil Nadu. Promoting women's education and economic empowerment, could play a critical role in mitigating long-term disparities in healthcare.</p>\n </section>\n </div>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":"40 5","pages":"1151-1166"},"PeriodicalIF":1.8000,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Health Planning and Management","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/hpm.3950","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Financial hardship is among the significant challenges in the utilization of maternal healthcare services in India. It is further aggravated by the issue of inequality in the distress financing (DF) for institutional delivery (ID) which pushes the poor into a vicious cycle of poverty. The paper examines the pattern of inequality and regional variation in DF for ID in India. It also determines the factor contributing to the inequality in the DF for ID among a few selected states.

Methods

The paper uses unit-level data from the fifth National Family Health Survey (NFHS-5) round conducted during 2019-21. The concentration curve (CC) and concentration index (CI) capture the inequalities in DF for ID. Also, the decomposition analysis of CI was performed to capture the contribution of key determinants in explaining the inequality in DF for ID.

Results

The study reveals that 16.3% of women in India incurred DF for ID, with the poorest quintile facing the highest burden (21.2%). Significant regional variations exist, with states like Telangana (30%) and Manipur (29.9%) showing the highest DF rates. Borrowing is the primary coping mechanism, particularly among the poorest. The concentration index (CI) analysis indicates that DF dominates among poorer women across states. Decomposition analysis highlights wealth status and education as the major contributors to inequality in DF, with significant regional disparities.

Conclusions

Addressing DF for ID requires strengthening maternity benefit schemes like Janani Suraksha Yojana (JSY) to cover indirect costs and ensure timely disbursements while curbing informal charges. Reducing out-of-pocket expenditure (OOPE) through improving accessibility and quality of public hospitals and regulation of private facility fees is essential. Alongside, expanding health insurance for comprehensive maternity care is essential, particularly in high-inequality states like Telangana, Kerala, and Tamil Nadu. Promoting women's education and economic empowerment, could play a critical role in mitigating long-term disparities in healthcare.

查看原文本刊更多论文

印度机构交付的困境融资：经济不平等、应对机制和促成因素的区域分析。

背景：经济困难是印度利用孕产妇保健服务面临的重大挑战之一。制度交付（ID）的困境融资（DF）不平等问题进一步加剧了这一问题，这将穷人推入贫困的恶性循环。本文考察了印度gdp的不平等格局和地区差异。它还决定了在几个选定的州中导致ID DF不平等的因素。方法：本文使用2019-21年第五轮全国家庭健康调查（NFHS-5）的单位数据。浓度曲线（CC）和浓度指数（CI）反映了DF对ID的不平等。此外，对CI进行了分解分析，以捕捉关键决定因素在解释DF对ID的不平等方面的贡献。结果：研究显示，16.3%的印度妇女因ID而接受DF，其中最贫穷的五分之一面临着最高的负担（21.2%）。显著的地区差异存在，像特伦甘纳邦（30%）和曼尼普尔邦（29.9%）这样的邦显示出最高的DF率。借款是主要的应对机制，对最贫穷的人来说尤其如此。浓度指数（CI）分析表明，DF在各州的贫困妇女中占主导地位。分解分析表明，财富状况和教育是造成发展中国家不平等的主要因素，地区差异显著。结论：解决残疾补贴问题需要加强Janani Suraksha Yojana （JSY）等产妇福利计划，以覆盖间接成本并确保及时支付，同时遏制非正式收费。必须通过改善公立医院的可及性和质量以及管制私立医院的收费来减少自付费用。此外，扩大全面产妇保健的医疗保险至关重要，特别是在特伦甘纳邦、喀拉拉邦和泰米尔纳德邦等不平等程度高的邦。促进妇女的教育和经济赋权，可在减轻保健方面的长期差距方面发挥关键作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

International Journal of Health Planning and Management Multiple-

CiteScore

4.50

自引率

3.70%

发文量

197

期刊介绍： Policy making and implementation, planning and management are widely recognized as central to effective health systems and services and to better health. Globalization, and the economic circumstances facing groups of countries worldwide, meanwhile present a great challenge for health planning and management. The aim of this quarterly journal is to offer a forum for publications which direct attention to major issues in health policy, planning and management. The intention is to maintain a balance between theory and practice, from a variety of disciplines, fields and perspectives. The Journal is explicitly international and multidisciplinary in scope and appeal: articles about policy, planning and management in countries at various stages of political, social, cultural and economic development are welcomed, as are those directed at the different levels (national, regional, local) of the health sector. Manuscripts are invited from a spectrum of different disciplines e.g., (the social sciences, management and medicine) as long as they advance our knowledge and understanding of the health sector. The Journal is therefore global, and eclectic.