Background: Institutional delivery has remained expensive for poor households due to hidden costs. Hidden costs are the costs that are not accounted for in hospital cost. The aim of this study was to estimate the hidden costs of institutional delivery and to identify associated factors.
Methods: Health facility based descriptive cross sectional study was conducted in Bale zone from August 13 to September 2, 2018. Exit interview was conducted among women who gave birth at selected hospitals. A total of 390 women from one referral hospital and two general hospitals were included into the study. Systematic sampling technique was used to select study participants. Multiple linear regression analysis was done to identify the predictors of the hidden cost of institutional delivery. A significance level of 0.05 was used.
Result: The median hidden cost of institutional delivery was, 877.5 ETB (31.94USD). The median of direct medical cost of normal delivery was 280 ETB (10.22USD) while the direct non medical cost was 230 ETB (8.40USD). For the cesarean section, the median direct medical cost was 10.66USD while indirect costs were 21.6USD. For forceps type of delivery, the direct medical cost was 362 ETB (13.21USD) while the direct medical cost was 360 (13.14USD). Distance of household from the hospital (β=.165), length of stay at the hospital (β=.050), mode of delivery (β=-.067) and family monthly income (β=.201) were the explanatory variables significantly associated with the hidden cost.
Conclusion: This study showed hidden cost of institutional delivery was high. Distance, length of stay, income and mode of delivery were the predictor of hidden cost. Decentralizing and taking skilled delivery service to the needy communities in order to reduce the hidden costs.
Keywords: Hidden Costs, Hospital costs, Institutional delivery, Ethiopia