Financial implications of preterm birth during initial hospitalization: The extent and predictors of catastrophic health expenditure

Abstract

ABSTRACTPreterm birth incidence has risen globally and the high cost of initial hospitalization poses financial burden to the family. This study assessed family cost at neonatal intensive care units of two hospitals in the state of Kedah, Malaysia. Family’s expenditure was obtained using a structured questionnaire. 126 families who were government employed spent a mean total cost of MYR 549 (MYR 0 - MYR 4,700) compared to MYR 650 (MYR 40 – MYR 9,300) for 244 families who were not government employed. Mean income loss was MYR 310 (MYR 0 – MYR 15,000) and MYR 348 (MYR 0 – MYR 5,500) respectively. Travel expenses was the cost driver for all families. 15% of families in this study were already living below the income poverty line and majority were not government employed. For the rest of the families, 21% became impoverished when one month household income was used for hospitalization cost but this lowered to 9% with cumulative household income by length of hospital stay. Overall incidence of catastrophic health expenditure among families was 38%. Using multivariable logistic regression household income and residential location were predictive factors for catastrophic health expenditure. Despite universal health coverage through subsidy of direct medical (hospital) cost, the high incidence of catastrophic health expenditure and impoverishment among families of preterm infants was attributable to out of pocket payment for direct non-medical cost (such as travel and food) and indirect cost from income loss. Government employed families with an array of employment benefits appear better protected against financial hardship compared to those in private sector or self-employed. Remedial measures include improving neonatal intensive care unit rooming-in service for mothers, complementary financial assistance for families and enhancing universal health coverage through affordable social health insurance for infant healthcare.