Out-of-pocket costs and catastrophic healthcare expenditure for families of children requiring surgery in sub-Saharan Africa.

Autor: Yap A; Center of Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA. Electronic address: ava.yap@ucsf.edu., Olatunji BT; Department of Paediatric Surgery, National Hospital Abuja, Abuja, Nigeria., Negash S; Department of Paediatric Surgery, Menelik II Hospital, Addis Ababa, Ethiopia., Mweru D; Department of Surgery, Centre Hospitalier Bethesda, Goma, Democratic Republic of Congo., Kisembo S; Department of Surgery, Centre Hospitalier Bethesda, Goma, Democratic Republic of Congo., Masumbuko F; Department of Surgery, Hôpital Provincial Général de Reférence de Bukavu, Bukavu, Democratic Republic of Congo., Ameh EA; Department of Paediatric Surgery, National Hospital Abuja, Abuja, Nigeria., Lebbie A; Department of Surgery, Connaught Hospital, Freetown, Sierra Leone., Bvulani B; Department of Surgery, University Teaching Hospital, Lusaka, Zambia., Hansen E; Department of Surgery, Kijabe Hospital, Kijabe, Kenya., Philipo GS; Department of Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania., Carroll M; Department of Surgery, Yale University School of Medicine, New Haven, CT., Hsu PJ; Department of Surgery, University of Michigan, Ann Arbor, MI., Bryce E; Kids Operating Room, Edinburgh, Scotland, United Kingdom; Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, United Kingdom., Cheung M; Department of Surgery, Yale University School of Medicine, New Haven, CT., Fedatto M; Kids Operating Room, Edinburgh, Scotland, United Kingdom., Laverde R; Center of Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA., Ozgediz D; Center of Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2023 Sep; Vol. 174 (3), pp. 567-573. Date of Electronic Publication: 2023 Jun 28.
DOI: 10.1016/j.surg.2023.05.010
Abstrakt: Background: Out-of-pocket healthcare costs leading to catastrophic healthcare expenditure pose a financial threat for families of children undergoing surgery in Sub-Saharan African countries, where universal healthcare coverage is often insufficient.
Methods: A prospective clinical and socioeconomic data collection tool was used in African hospitals with dedicated pediatric operating rooms installed philanthropically. Clinical data were collected via chart review and socioeconomic data from families. The primary indicator of economic burden was the proportion of families with catastrophic healthcare expenditures. Secondary indicators included the percentage who borrowed money, sold possessions, forfeited wages, and lost a job secondary to their child's surgery. Descriptive statistics and multivariate logistic regression were performed to identify predictors of catastrophic healthcare expenditure.
Results: In all, 2,296 families of pediatric surgical patients from 6 countries were included. The median annual income was $1,000 (interquartile range 308-2,563), whereas the median out-of-pocket cost was $60 (interquartile range 26-174). Overall, 39.9% (n = 915) families incurred catastrophic healthcare expenditure, 23.3% (n = 533) borrowed money, 3.8% (n = 88%) sold possessions, 26.4% (n = 604) forfeited wages, and 2.3% (n = 52) lost a job because of the child's surgery. Catastrophic healthcare expenditure was associated with older age, emergency cases, need for transfusion, reoperation, antibiotics, and longer length of stay, whereas the subgroup analysis found insurance to be protective (odds ratio 0.22, P = .002).
Conclusion: A full 40% of families of children in sub-Saharan Africa who undergo surgery incur catastrophic healthcare expenditure, shouldering economic consequences such as forfeited wages and debt. Intensive resource utilization and reduced insurance coverage in older children may contribute to a higher likelihood of catastrophic healthcare expenditure and can be insurance targets for policymakers.
(Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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