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The societal cost and economic impact of surgical care on patients’ households in rural Uganda; a mixed method study
BACKGROUND: The epidemiology and cost of surgical care delivery in low-and middle-income countries (LMICs) is poorly understood. This study characterizes the cost of surgical care, rate of catastrophic medical expenditure and medical impoverishment, and impact of surgical hospitalization on patients...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190862/ https://www.ncbi.nlm.nih.gov/pubmed/34107950 http://dx.doi.org/10.1186/s12913-021-06579-x |
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author | Nwanna–Nzewunwa, Obieze Oke, Rasheedat Agwang, Esther Ajiko, Mary-Margaret Yoon, Christopher Carvalho, Melissa Kirya, Fred Marseille, Elliot Dicker, Rochelle A. |
author_facet | Nwanna–Nzewunwa, Obieze Oke, Rasheedat Agwang, Esther Ajiko, Mary-Margaret Yoon, Christopher Carvalho, Melissa Kirya, Fred Marseille, Elliot Dicker, Rochelle A. |
author_sort | Nwanna–Nzewunwa, Obieze |
collection | PubMed |
description | BACKGROUND: The epidemiology and cost of surgical care delivery in low-and middle-income countries (LMICs) is poorly understood. This study characterizes the cost of surgical care, rate of catastrophic medical expenditure and medical impoverishment, and impact of surgical hospitalization on patients’ households at Soroti Regional Referral Hospital (SRRH), Uganda. METHODS: We prospectively collected demographic, clinical, and cost data from all surgical inpatients and caregivers at SRRH between February 2018 and January 2019. We conducted and thematically analyzed qualitative interviews to discern the impact of hospitalization on patients’ households. We employed the chi-square, t-test, ANOVA, and Bonferroni tests and built regression models to identify predictors of societal cost of surgical care. Out of pocket spending (OOPS) and catastrophic expenses were determined. RESULTS: We encountered 546 patients, mostly male (62%) peasant farmers (42%), at a median age of 22 years; and 615 caregivers, typically married (87%), female (69%), at a median age of 35 years. Femur fractures (20.4%), soft tissue infections (12.3%), and non-femur fractures (11.9%) were commonest. The total societal cost of surgical care was USD 147,378 with femur fractures (USD 47,879), intestinal obstruction (USD 18,737) and non-femur fractures (USD 10,212) as the leading contributors. Procedures (40%) and supplies (12%) were the largest components of societal cost. About 29% of patients suffered catastrophic expenses and 31% were medically impoverished. CONCLUSION: Despite free care, surgical conditions cause catastrophic expenses and impoverishment in Uganda. Femur fracture is the most expensive surgical condition due to prolonged hospitalization associated with traction immobilization and lack of treatment modalities with shorter hospitalization. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06579-x. |
format | Online Article Text |
id | pubmed-8190862 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-81908622021-06-10 The societal cost and economic impact of surgical care on patients’ households in rural Uganda; a mixed method study Nwanna–Nzewunwa, Obieze Oke, Rasheedat Agwang, Esther Ajiko, Mary-Margaret Yoon, Christopher Carvalho, Melissa Kirya, Fred Marseille, Elliot Dicker, Rochelle A. BMC Health Serv Res Research Article BACKGROUND: The epidemiology and cost of surgical care delivery in low-and middle-income countries (LMICs) is poorly understood. This study characterizes the cost of surgical care, rate of catastrophic medical expenditure and medical impoverishment, and impact of surgical hospitalization on patients’ households at Soroti Regional Referral Hospital (SRRH), Uganda. METHODS: We prospectively collected demographic, clinical, and cost data from all surgical inpatients and caregivers at SRRH between February 2018 and January 2019. We conducted and thematically analyzed qualitative interviews to discern the impact of hospitalization on patients’ households. We employed the chi-square, t-test, ANOVA, and Bonferroni tests and built regression models to identify predictors of societal cost of surgical care. Out of pocket spending (OOPS) and catastrophic expenses were determined. RESULTS: We encountered 546 patients, mostly male (62%) peasant farmers (42%), at a median age of 22 years; and 615 caregivers, typically married (87%), female (69%), at a median age of 35 years. Femur fractures (20.4%), soft tissue infections (12.3%), and non-femur fractures (11.9%) were commonest. The total societal cost of surgical care was USD 147,378 with femur fractures (USD 47,879), intestinal obstruction (USD 18,737) and non-femur fractures (USD 10,212) as the leading contributors. Procedures (40%) and supplies (12%) were the largest components of societal cost. About 29% of patients suffered catastrophic expenses and 31% were medically impoverished. CONCLUSION: Despite free care, surgical conditions cause catastrophic expenses and impoverishment in Uganda. Femur fracture is the most expensive surgical condition due to prolonged hospitalization associated with traction immobilization and lack of treatment modalities with shorter hospitalization. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06579-x. BioMed Central 2021-06-09 /pmc/articles/PMC8190862/ /pubmed/34107950 http://dx.doi.org/10.1186/s12913-021-06579-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Nwanna–Nzewunwa, Obieze Oke, Rasheedat Agwang, Esther Ajiko, Mary-Margaret Yoon, Christopher Carvalho, Melissa Kirya, Fred Marseille, Elliot Dicker, Rochelle A. The societal cost and economic impact of surgical care on patients’ households in rural Uganda; a mixed method study |
title | The societal cost and economic impact of surgical care on patients’ households in rural Uganda; a mixed method study |
title_full | The societal cost and economic impact of surgical care on patients’ households in rural Uganda; a mixed method study |
title_fullStr | The societal cost and economic impact of surgical care on patients’ households in rural Uganda; a mixed method study |
title_full_unstemmed | The societal cost and economic impact of surgical care on patients’ households in rural Uganda; a mixed method study |
title_short | The societal cost and economic impact of surgical care on patients’ households in rural Uganda; a mixed method study |
title_sort | societal cost and economic impact of surgical care on patients’ households in rural uganda; a mixed method study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190862/ https://www.ncbi.nlm.nih.gov/pubmed/34107950 http://dx.doi.org/10.1186/s12913-021-06579-x |
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