Cargando…

What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure

OBJECTIVES: To measure the financial burden associated with accessing surgical care in Sierra Leone. DESIGN: A cross-sectional survey conducted with patients at the time of discharge from tertiary-level care. This captured demographics, yearly household expenditure, direct medical, direct non-medica...

Descripción completa

Detalles Bibliográficos
Autores principales: Phull, Manraj, Grimes, Caris E, Kamara, Thaim B, Wurie, Haja, Leather, Andy J M, Davies, Justine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7942261/
https://www.ncbi.nlm.nih.gov/pubmed/34006018
http://dx.doi.org/10.1136/bmjopen-2020-039049
_version_ 1783662282596679680
author Phull, Manraj
Grimes, Caris E
Kamara, Thaim B
Wurie, Haja
Leather, Andy J M
Davies, Justine
author_facet Phull, Manraj
Grimes, Caris E
Kamara, Thaim B
Wurie, Haja
Leather, Andy J M
Davies, Justine
author_sort Phull, Manraj
collection PubMed
description OBJECTIVES: To measure the financial burden associated with accessing surgical care in Sierra Leone. DESIGN: A cross-sectional survey conducted with patients at the time of discharge from tertiary-level care. This captured demographics, yearly household expenditure, direct medical, direct non-medical and indirect costs for surgical care, and summary household assets. Missing data were imputed. SETTING: The main tertiary-level hospital in Freetown, Sierra Leone. PARTICIPANTS: 335 surgical patients under the care of the hospital surgical team receiving operative or non-operative surgical care on the surgical wards. OUTCOME MEASURES: Rates of catastrophic expenditure (a cost >10% of annual expenditure), impoverishment (being pushed into, or further into, poverty as a result of surgical care costs), amount of out-of-pocket (OOP) costs and means used to meet these costs were derived. RESULTS: Of 335 patients interviewed, 39% were female and 80% were urban dwellers. Median yearly household expenditure was US$3569. Mean OOP costs were US$243, of which a mean of US$24 (10%) was spent prehospital. Of costs incurred during the hospital admission, direct medical costs were US$138 (63%) and US$34 (16%) were direct non-medical costs. US$46 (21%) were indirect costs. Catastrophic expenditure affected 18% of those interviewed. Concerning impoverishment, 45% of patients were already below the national poverty line prior to admission, and 9% of those who were not were pushed below the poverty line following payment for surgical care. 84% of patients used household savings to meet OOP costs. Only 2% (six patients) had health insurance. CONCLUSION: Obtaining surgical care has substantial economic impacts on households that pushes them into poverty or further into poverty. The much-needed scaling up of surgical care needs to be accompanied by financial risk protection.
format Online
Article
Text
id pubmed-7942261
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-79422612021-03-24 What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure Phull, Manraj Grimes, Caris E Kamara, Thaim B Wurie, Haja Leather, Andy J M Davies, Justine BMJ Open Health Economics OBJECTIVES: To measure the financial burden associated with accessing surgical care in Sierra Leone. DESIGN: A cross-sectional survey conducted with patients at the time of discharge from tertiary-level care. This captured demographics, yearly household expenditure, direct medical, direct non-medical and indirect costs for surgical care, and summary household assets. Missing data were imputed. SETTING: The main tertiary-level hospital in Freetown, Sierra Leone. PARTICIPANTS: 335 surgical patients under the care of the hospital surgical team receiving operative or non-operative surgical care on the surgical wards. OUTCOME MEASURES: Rates of catastrophic expenditure (a cost >10% of annual expenditure), impoverishment (being pushed into, or further into, poverty as a result of surgical care costs), amount of out-of-pocket (OOP) costs and means used to meet these costs were derived. RESULTS: Of 335 patients interviewed, 39% were female and 80% were urban dwellers. Median yearly household expenditure was US$3569. Mean OOP costs were US$243, of which a mean of US$24 (10%) was spent prehospital. Of costs incurred during the hospital admission, direct medical costs were US$138 (63%) and US$34 (16%) were direct non-medical costs. US$46 (21%) were indirect costs. Catastrophic expenditure affected 18% of those interviewed. Concerning impoverishment, 45% of patients were already below the national poverty line prior to admission, and 9% of those who were not were pushed below the poverty line following payment for surgical care. 84% of patients used household savings to meet OOP costs. Only 2% (six patients) had health insurance. CONCLUSION: Obtaining surgical care has substantial economic impacts on households that pushes them into poverty or further into poverty. The much-needed scaling up of surgical care needs to be accompanied by financial risk protection. BMJ Publishing Group 2021-03-08 /pmc/articles/PMC7942261/ /pubmed/34006018 http://dx.doi.org/10.1136/bmjopen-2020-039049 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Health Economics
Phull, Manraj
Grimes, Caris E
Kamara, Thaim B
Wurie, Haja
Leather, Andy J M
Davies, Justine
What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure
title What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure
title_full What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure
title_fullStr What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure
title_full_unstemmed What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure
title_short What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure
title_sort what is the financial burden to patients of accessing surgical care in sierra leone? a cross-sectional survey of catastrophic and impoverishing expenditure
topic Health Economics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7942261/
https://www.ncbi.nlm.nih.gov/pubmed/34006018
http://dx.doi.org/10.1136/bmjopen-2020-039049
work_keys_str_mv AT phullmanraj whatisthefinancialburdentopatientsofaccessingsurgicalcareinsierraleoneacrosssectionalsurveyofcatastrophicandimpoverishingexpenditure
AT grimescarise whatisthefinancialburdentopatientsofaccessingsurgicalcareinsierraleoneacrosssectionalsurveyofcatastrophicandimpoverishingexpenditure
AT kamarathaimb whatisthefinancialburdentopatientsofaccessingsurgicalcareinsierraleoneacrosssectionalsurveyofcatastrophicandimpoverishingexpenditure
AT wuriehaja whatisthefinancialburdentopatientsofaccessingsurgicalcareinsierraleoneacrosssectionalsurveyofcatastrophicandimpoverishingexpenditure
AT leatherandyjm whatisthefinancialburdentopatientsofaccessingsurgicalcareinsierraleoneacrosssectionalsurveyofcatastrophicandimpoverishingexpenditure
AT daviesjustine whatisthefinancialburdentopatientsofaccessingsurgicalcareinsierraleoneacrosssectionalsurveyofcatastrophicandimpoverishingexpenditure