Household Catastrophic Health Expenditures in Maternal Care: A Cross-Sectional Study From Semnan, Iran

Abstract

Background: Due to its indisputable influence on maternal and child health, maternal care is among the most crucial requisites in all health systems.

Objective: This study aimed to investigate the catastrophic health expenditures (CHE) in maternal care.

Methods: This cross-sectional survey included 400 pregnant women using systematic random sampling in Semnan, Iran, from July 1, 2022, to September 30, 2022. The study tool was a researcher-made questionnaire, the content validity of which was approved by experts, and CVR and CVI values of 0.89 and 0.91, respectively. The CHE occurs when out-of-pocket medical expenditures account for 40% of household affordability and more, so all pregnancy-related healthcare costs were recorded, and their ratio to the household's nonfood costs was calculated. Due to the qualitative nature of the data, a chi-square test was performed to evaluate the statistical association between demographic and background variables with CHE.

Results: The mean direct costs for maternal care was $1697, of which 48% was related to diagnostic services, 11% to various therapies, and 41% to medical treatment. The ratio of direct costs to nonfood costs was 48.67%, and 50% of pregnant women and their households suffered from CHE. Furthermore, the factors of educational status, employment status, basic health insurance, supplementary health insurance, mode of delivery, place of delivery, place of receiving care, and the woman's weight during pregnancy had statistically significant relationships with CHE (p < 0.05).

Conclusions: The status of financial support provided to Iranian pregnant women is not desirable. The Iranian health system should reduce the incidence of CHE in maternal care by taking the following steps: (1) fully covering the costs of maternal care services by strengthening insurance facilities, (2) investing enough money in domestic procurement of diagnostic technology and medical supplements, and (3) providing high-quality maternal care in the public sector facilities.

Keywords: catastrophic health expenditure; maternal care; out‐of‐pocket cost; social protection.