Objectives: The Government of Nepal revised free maternity health services, “Aama Surakshya Karyakram”, beginning at the start of Fiscal Year 2012/13, which specifies the services to be funded, the tariffs for reimbursement, and the system for claiming and reporting on free deliveries each month. This study was designed to investigate the amount of monetary expenditure incurred by families using apparently free maternity services.
Methods: Between August 2014 and December 2014, a hospital-based cross-sectional study was conducted at Manipal Teaching Hospital and Western Regional Hospital. Nepalese women were not involved with family finances and had very little knowledge of income or expenditures. Therefore, face-to-face interviews with 384 postpartum mothers with their husbands or the head of the family household were conducted at the time of discharge by using a pre-tested semi-structural questionnaire.
Results: The average monthly family income was 19,272.4 NRs (189.01 US),themediandurationofhospitalstaywas4days(range,2?19days),andthemedianpatientexpenditurewasequivalentto13). When the average total hidden cost of 27,288.5 NRs (267.6 US)wasadded,thentheaveragetotalmaternitycareexpenditurewas31,175.6NRs(305.76US), with an average cost per day of 7,167.5 NRs (70.29 US).Themeanpatientexpenditureonfoodanddrink,clothes,transport,andmedicinewasequivalentto53.07), 7,429.3 NRs (72.9 US),and6,175.9NRs(60.6US), respectively.
Conclusion: The free maternity service in Nepal has high out-of-pocket expenditures, and did not represent a system completely free of costs. Therefore, arrangements should be made by hospitals free of cost to provide medicine that is not included as essential during the hospital stay and at discharge time. Similarly, arrangements for liquid, food, and hot water, as well as clothes for mothers and newborns, should be made by the hospital in order to enhance hospital attendance.
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