Surgical Catastrophic Health Expenditure and Risk Factors for Out-of-Pocket Expenditure at a South African Public Sector Hospital.

Autor: Naidu P; Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. pnaidu2012@gmail.com.; Centre for Global Surgery, Department of Global of Health, Tygerberg Hospital, Stellenbosch University, Francie Van Zijl Drive, Cape Town, 7505, South Africa. pnaidu2012@gmail.com., Ataguba JE; Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa., Shrime M; Institute of Global Surgery, Royal College of Surgeons, Dublin, Ireland.; Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA., Alkire BC; Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA., Chu KM; Centre for Global Surgery, Department of Global of Health, Tygerberg Hospital, Stellenbosch University, Francie Van Zijl Drive, Cape Town, 7505, South Africa.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2022 Apr; Vol. 46 (4), pp. 769-775. Date of Electronic Publication: 2022 Feb 14.
DOI: 10.1007/s00268-022-06472-6
Abstrakt: Background: Worldwide, 3.7 billion people risk financial catastrophe if they require surgery, mostly affecting the poorest populations. Surgical care associated with catastrophic health expenditure (CHE) has not been well-described in the South African context. The objectives of this study were to determine: (1) the proportion of surgical patients at a South African hospital who experienced CHE and impoverishing health expenditure (IHE); and (2) the risk factors for out-of-pocket (OOP) payments.
Methods: A cross-sectional prospective questionnaire was administered to participants admitted for a surgical procedure at New Somerset Hospital, Cape Town. CHE was defined in three ways: (1) 40% or more of capacity-to-pay, (2) 25% of annual household expenditure, or (3) 10% of annual household expenditure. IHE was described as the number of participants who experienced new or worsening impoverishment after surgery.
Results: Two hundred and seventy-four participants were interviewed, and 263 were included in the analysis (4% attrition rate). Two (0.8%) participants experienced CHE. 98.5% of participants spent less than 10% of their annual household expenditure and 43 participants (16.7%) experienced IHE. Risk factors for OOP expenditure were cancer diagnosis (p = 0.0386), an elective procedure (p = 0.0001), and having a limited health insurance plan (p = 0.0492).
Discussion: Most participants undergoing a surgical procedure did not experience CHE. Participants were relatively protected from financial catastrophe owing to subsidized user fees and the provision of transport. However, 17% of patients experienced IHE, suggesting even small payments resulted in impoverishment. Ensuring low financial vulnerabilities around surgical care is an important consideration for national surgical planning in South Africa.
(© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)
Databáze: MEDLINE
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