Impact of out-of-pocket expenses for surgical care on households in rural Haiti: a mixed-methods study.

Autor:	Padovany MM; General Surgery, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti., Patterson RH; Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA rolvixiii@gmail.com., Bowder AN; Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., O'Brien E; University of Miami Miller School of Medicine, University of Miami, Miami, Florida, USA., Alkire BC; Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA., Katz AM; Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA., Mitnick CD; Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA., Lu C; Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Division of Global Health Equity, Brigham & Women's Hospital, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2022 May 24; Vol. 12 (5), pp. e061731. Date of Electronic Publication: 2022 May 24.
DOI:	10.1136/bmjopen-2022-061731
Abstrakt:	Objectives: This study aimed to report household catastrophic spending on surgery and the experiences of patients and families seeking surgical care in rural Haiti. Design: The study used an explanatory, sequential mixed-methods approach. We collected both quantitative and qualitative data from the participants through interviews. Setting: A rural tertiary hospital (St. Boniface Hospital) in southern Haiti. Participants: There were 200 adult Haitian surgical patients who entered the study. Of these, 41 were excluded due to missing variables or health expenditure outliers. The final sample included 159 participants. Primary and Secondary Outcome Measures: The primary outcomes were (1) direct and indirect payments for surgical care; (2) the rate of catastrophic health expenditure (CHE) (as defined by the Sustainable Development Goals (10% of total household expenditure) and WHO (10%, 20%, 30% and 40% of household capacity to pay)) due to surgical care; and (3) common themes across the lived experiences of households of surgical patients seeking care. Results: The median household expenditure on surgery-related expenses was US$385.6, slightly more than half of per capita gross domestic product in Haiti (US$729.3). Up to 86% of households experienced CHE, as defined by the Sustainable Development Goals, due to receiving surgical care. Patients commonly paid for surgical costs through loans and donations (69.8%). The qualitative analysis revealed prominent themes related to barriers to care including the burden of initiating care-seeking, care-seeking journeys and social suffering. Conclusions: CHE is common for Haitian surgical patients, and the associated care-seeking experiences are often arduous. These findings suggest that low, flat fees in non-profit hospital settings may not be sufficient to mitigate the costs of surgical care or the resulting challenges that patients experience. Competing Interests: Competing interests: MP, RP, AB, EO, AK, CM, and CL have nothing to disclose. BA reports grants from Mercy Ships to perform outcomes research outside the submitted work. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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