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Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone: An evaluation of the free health care initiative
BACKGROUND: Utilizing surgical services, including caesarean sections, can result in catastrophic expenditure and impoverishment. In 2010, Sierra Leone introduced the Free Health Care Initiative (FHCI), a national financial risk protection program for the most vulnerable groups. Aim of this study wa...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519447/ https://www.ncbi.nlm.nih.gov/pubmed/34653191 http://dx.doi.org/10.1371/journal.pone.0258532 |
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author | van Duinen, Alex J. Westendorp, Josien Ashley, Thomas Hagander, Lars Holmer, Hampus Koroma, Alimamy P. Leather, Andrew J. M. Shrime, Mark G. Wibe, Arne Bolkan, Håkon A. |
author_facet | van Duinen, Alex J. Westendorp, Josien Ashley, Thomas Hagander, Lars Holmer, Hampus Koroma, Alimamy P. Leather, Andrew J. M. Shrime, Mark G. Wibe, Arne Bolkan, Håkon A. |
author_sort | van Duinen, Alex J. |
collection | PubMed |
description | BACKGROUND: Utilizing surgical services, including caesarean sections, can result in catastrophic expenditure and impoverishment. In 2010, Sierra Leone introduced the Free Health Care Initiative (FHCI), a national financial risk protection program for the most vulnerable groups. Aim of this study was to investigate catastrophic expenditure and impoverishment related to caesarean section in Sierra Leone and evaluate the impact of the FHCI. METHODS: Women who delivered by caesarean section in nine hospitals were followed up with home visits one month after surgery, and data on medical and non-medical expenditures were collected. Individual income was estimated based on household characteristics and used to determine catastrophic expenditure and impoverishment for each patient. The impact of the FHCI was assessed by comparing actual expenditure with counterfactual expenditures had the initiative not existed. RESULTS: For the 1146 patients in the study, the median expenditure was 23 (IQR 4; 56) international dollars (Int$). Patients in the poorest quintile spent a median Int$ 59 (IQR 28; 76), which was significantly more than patients in the richest quintile, who spent a median Int$ 17 (IQR 2; 38, p<0.001). Travel (32.9%) and food (28.7%) were the two largest expenses. Catastrophic expenditure was encountered by 12.0% and 4.0% (10% and 25% threshold, respectively) of the women. Without the FHCI, 66.1% and 28.8% of the women would have encountered catastrophic expenditure. CONCLUSION: Many women in Sierra Leone face catastrophic expenditure related to caesarean section, mainly through food and travel expenses, and the poor are disproportionally affected. The FHCI is effective in reducing the risk of catastrophic expenditure related to caesarean section, but many patients are still exposed to financial hardship, suggesting that additional support is needed for Sierra Leone’s poorest patients. |
format | Online Article Text |
id | pubmed-8519447 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-85194472021-10-16 Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone: An evaluation of the free health care initiative van Duinen, Alex J. Westendorp, Josien Ashley, Thomas Hagander, Lars Holmer, Hampus Koroma, Alimamy P. Leather, Andrew J. M. Shrime, Mark G. Wibe, Arne Bolkan, Håkon A. PLoS One Research Article BACKGROUND: Utilizing surgical services, including caesarean sections, can result in catastrophic expenditure and impoverishment. In 2010, Sierra Leone introduced the Free Health Care Initiative (FHCI), a national financial risk protection program for the most vulnerable groups. Aim of this study was to investigate catastrophic expenditure and impoverishment related to caesarean section in Sierra Leone and evaluate the impact of the FHCI. METHODS: Women who delivered by caesarean section in nine hospitals were followed up with home visits one month after surgery, and data on medical and non-medical expenditures were collected. Individual income was estimated based on household characteristics and used to determine catastrophic expenditure and impoverishment for each patient. The impact of the FHCI was assessed by comparing actual expenditure with counterfactual expenditures had the initiative not existed. RESULTS: For the 1146 patients in the study, the median expenditure was 23 (IQR 4; 56) international dollars (Int$). Patients in the poorest quintile spent a median Int$ 59 (IQR 28; 76), which was significantly more than patients in the richest quintile, who spent a median Int$ 17 (IQR 2; 38, p<0.001). Travel (32.9%) and food (28.7%) were the two largest expenses. Catastrophic expenditure was encountered by 12.0% and 4.0% (10% and 25% threshold, respectively) of the women. Without the FHCI, 66.1% and 28.8% of the women would have encountered catastrophic expenditure. CONCLUSION: Many women in Sierra Leone face catastrophic expenditure related to caesarean section, mainly through food and travel expenses, and the poor are disproportionally affected. The FHCI is effective in reducing the risk of catastrophic expenditure related to caesarean section, but many patients are still exposed to financial hardship, suggesting that additional support is needed for Sierra Leone’s poorest patients. Public Library of Science 2021-10-15 /pmc/articles/PMC8519447/ /pubmed/34653191 http://dx.doi.org/10.1371/journal.pone.0258532 Text en © 2021 van Duinen et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article van Duinen, Alex J. Westendorp, Josien Ashley, Thomas Hagander, Lars Holmer, Hampus Koroma, Alimamy P. Leather, Andrew J. M. Shrime, Mark G. Wibe, Arne Bolkan, Håkon A. Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone: An evaluation of the free health care initiative |
title | Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone: An evaluation of the free health care initiative |
title_full | Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone: An evaluation of the free health care initiative |
title_fullStr | Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone: An evaluation of the free health care initiative |
title_full_unstemmed | Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone: An evaluation of the free health care initiative |
title_short | Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone: An evaluation of the free health care initiative |
title_sort | catastrophic expenditure and impoverishment after caesarean section in sierra leone: an evaluation of the free health care initiative |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519447/ https://www.ncbi.nlm.nih.gov/pubmed/34653191 http://dx.doi.org/10.1371/journal.pone.0258532 |
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