Out-of-Pocket Costs for Facility-Based Obstetrical Care in Rural Guatemala

Background: Rural Indigenous Maya communities in Guatemala have some of the worst obstetrical health outcomes in Latin America, due to widespread discrimination in healthcare and an underfunded public sector. Multiple systems-level efforts to improve facility birth outcomes have been implemented, pr...

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Autores principales:	Michel Juarez, Kirsten Austad, Peter Rohloff
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2021
Materias:	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/de70bcec480d475fa9cd4c51d60d2679
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spelling	oai:doaj.org-article:de70bcec480d475fa9cd4c51d60d26792021-12-02T19:13:58ZOut-of-Pocket Costs for Facility-Based Obstetrical Care in Rural Guatemala2214-999610.5334/aogh.3223https://doaj.org/article/de70bcec480d475fa9cd4c51d60d26792021-08-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/3223https://doaj.org/toc/2214-9996Background: Rural Indigenous Maya communities in Guatemala have some of the worst obstetrical health outcomes in Latin America, due to widespread discrimination in healthcare and an underfunded public sector. Multiple systems-level efforts to improve facility birth outcomes have been implemented, primarily focusing on early community-based detection of obstetrical complications and on reducing discrimination and improving the quality of facility-level care. However, another important feature of public facility-level care are the out-of-pocket payments that patients are often required to make for care. Objective: To estimate the burden of out-of-pocket costs for public obstetrical care in Indigenous Maya communities in Guatemala. Methods: We conducted a retrospective review of electronic medical record data on obstetrical referrals collected as part of an obstetrical care navigation intervention, which included documentation of out-of-pocket costs by care navigators accompanying patients within public facilities. We compared the median costs for both emergency and routine obstetrical facility care. Findings: Cost data on 709 obstetric referrals from 479 patients were analyzed (65% emergency and 35% routine referrals). The median OOP costs were Q100 (IQR 75–150) [$13 USD] and Q50 (IQR 16–120) [$6.50 USD] for emergency and routine referrals. Costs for transport were most common (95% and 55%, respectively). Costs for medication, supply, laboratory, and imaging costs occurred less frequently. Food and lodging costs were minimal. Conclusion: Out-of-pocket payments for theoretically free public care are a common and important barrier to care for this rural Guatemalan setting. These data add to the literature in Latin American on the barriers to obstetrical care faced by Indigenous and rural women.Michel JuarezKirsten AustadPeter RohloffUbiquity PressarticleInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 87, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Michel Juarez Kirsten Austad Peter Rohloff Out-of-Pocket Costs for Facility-Based Obstetrical Care in Rural Guatemala
description	Background: Rural Indigenous Maya communities in Guatemala have some of the worst obstetrical health outcomes in Latin America, due to widespread discrimination in healthcare and an underfunded public sector. Multiple systems-level efforts to improve facility birth outcomes have been implemented, primarily focusing on early community-based detection of obstetrical complications and on reducing discrimination and improving the quality of facility-level care. However, another important feature of public facility-level care are the out-of-pocket payments that patients are often required to make for care. Objective: To estimate the burden of out-of-pocket costs for public obstetrical care in Indigenous Maya communities in Guatemala. Methods: We conducted a retrospective review of electronic medical record data on obstetrical referrals collected as part of an obstetrical care navigation intervention, which included documentation of out-of-pocket costs by care navigators accompanying patients within public facilities. We compared the median costs for both emergency and routine obstetrical facility care. Findings: Cost data on 709 obstetric referrals from 479 patients were analyzed (65% emergency and 35% routine referrals). The median OOP costs were Q100 (IQR 75–150) [$13 USD] and Q50 (IQR 16–120) [$6.50 USD] for emergency and routine referrals. Costs for transport were most common (95% and 55%, respectively). Costs for medication, supply, laboratory, and imaging costs occurred less frequently. Food and lodging costs were minimal. Conclusion: Out-of-pocket payments for theoretically free public care are a common and important barrier to care for this rural Guatemalan setting. These data add to the literature in Latin American on the barriers to obstetrical care faced by Indigenous and rural women.
format	article
author	Michel Juarez Kirsten Austad Peter Rohloff
author_facet	Michel Juarez Kirsten Austad Peter Rohloff
author_sort	Michel Juarez
title	Out-of-Pocket Costs for Facility-Based Obstetrical Care in Rural Guatemala
title_short	Out-of-Pocket Costs for Facility-Based Obstetrical Care in Rural Guatemala
title_full	Out-of-Pocket Costs for Facility-Based Obstetrical Care in Rural Guatemala
title_fullStr	Out-of-Pocket Costs for Facility-Based Obstetrical Care in Rural Guatemala
title_full_unstemmed	Out-of-Pocket Costs for Facility-Based Obstetrical Care in Rural Guatemala
title_sort	out-of-pocket costs for facility-based obstetrical care in rural guatemala
publisher	Ubiquity Press
publishDate	2021
url	https://doaj.org/article/de70bcec480d475fa9cd4c51d60d2679
work_keys_str_mv	AT micheljuarez outofpocketcostsforfacilitybasedobstetricalcareinruralguatemala AT kirstenaustad outofpocketcostsforfacilitybasedobstetricalcareinruralguatemala AT peterrohloff outofpocketcostsforfacilitybasedobstetricalcareinruralguatemala
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Out-of-Pocket Costs for Facility-Based Obstetrical Care in Rural Guatemala

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