Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Community Medicine

Methods: All females aged 15-49 years were identified for inclusion in the study sampling frame. A simple random sample of 300 females was selected from this sampling frame. Patients were interviewed with a semi-structured, in-depth questionnaire. Results: All interviewees incurred substantial out-of-pocket expenditures for travel, hospital admission fees, medicine, tests, food, and tips. Only two of the expenditures, travel expenses and admission fees, were not supposed to be provided free of charge by the hospital. The median total per-patient expenditure was L.E 235 (range L.E 3{u2013}L.E 5574). One third of all patients reported that their families had to borrow to pay for care at interest rates of 0%. 3.3% of these families reported selling jewelry, livestock or household items. The rural patients expenditures were higher than the urban patients. Factors increasing the expenditures were duration of hospitalization, rural residence, and necessary (e.g. C-section) medical procedures. Conclusion: Free maternity services in Egypt impose large out-of-pocket expenditures on patients. Authorities could reduce the burden by reducing the duration of hospital stays, limiting use of medical procedures, eliminating tips, and moving routine services closer to potential users

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