M G Shrime1,2, A Dare3, B C Alkire4, J G Meara5,6. 1. Program in Global Surgery and Social Change, Harvard Medical School, Massachusetts, USA. shrime@mail.harvard.edu. 2. Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston Children's Hospital, Boston, Massachusetts, USA. shrime@mail.harvard.edu. 3. Department of Surgery, University of Toronto, Toronto, Canada. 4. Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston Children's Hospital, Boston, Massachusetts, USA. 5. Program in Global Surgery and Social Change, Harvard Medical School, Massachusetts, USA. 6. Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Approximately 30 per cent of the global burden of disease is surgical, and nearly one-quarter of individuals who undergo surgery each year face financial hardship because of its cost. The Lancet Commission on Global Surgery has proposed the elimination of impoverishment due to surgery by 2030, but no country-level estimates exist of the financial burden of surgical access. METHODS: Using publicly available data, the incidence and risk of financial hardship owing to surgery was estimated for each country. Four measures of financial catastrophe were examined: catastrophic expenditure, and impoverishment at the national poverty line, at 2 international dollars (I$) per day and at I$1·25 per day. Stochastic models of income and surgical costs were built for each country. Results were validated against available primary data. RESULTS: Direct medical costs of surgery put 43·9 (95 per cent posterior credible interval 2·2 to 87·1) per cent of the examined population at risk of catastrophic expenditure, and 57·0 (21·8 to 85·1) per cent at risk of being pushed below I$2 per day. The risk of financial hardship from surgery was highest in sub-Saharan Africa. Correlations were found between the risk of financial catastrophe and external financing of healthcare (positive correlation), national measures of well-being (negative correlation) and the percentage of a country's gross domestic product spent on healthcare (negative correlation). The model performed well against primary data on the costs of surgery. CONCLUSION: Country-specific estimates of financial catastrophe owing to surgical care are presented. The economic benefits projected to occur with the scale-up of surgery are placed at risk if the financial burden of accessing surgery is not addressed in national policies.
BACKGROUND: Approximately 30 per cent of the global burden of disease is surgical, and nearly one-quarter of individuals who undergo surgery each year face financial hardship because of its cost. The Lancet Commission on Global Surgery has proposed the elimination of impoverishment due to surgery by 2030, but no country-level estimates exist of the financial burden of surgical access. METHODS: Using publicly available data, the incidence and risk of financial hardship owing to surgery was estimated for each country. Four measures of financial catastrophe were examined: catastrophic expenditure, and impoverishment at the national poverty line, at 2 international dollars (I$) per day and at I$1·25 per day. Stochastic models of income and surgical costs were built for each country. Results were validated against available primary data. RESULTS: Direct medical costs of surgery put 43·9 (95 per cent posterior credible interval 2·2 to 87·1) per cent of the examined population at risk of catastrophic expenditure, and 57·0 (21·8 to 85·1) per cent at risk of being pushed below I$2 per day. The risk of financial hardship from surgery was highest in sub-Saharan Africa. Correlations were found between the risk of financial catastrophe and external financing of healthcare (positive correlation), national measures of well-being (negative correlation) and the percentage of a country's gross domestic product spent on healthcare (negative correlation). The model performed well against primary data on the costs of surgery. CONCLUSION: Country-specific estimates of financial catastrophe owing to surgical care are presented. The economic benefits projected to occur with the scale-up of surgery are placed at risk if the financial burden of accessing surgery is not addressed in national policies.
Authors: Rohan Khera; Javier Valero-Elizondo; Victor Okunrintemi; Anshul Saxena; Sandeep R Das; James A de Lemos; Harlan M Krumholz; Khurram Nasir Journal: JAMA Cardiol Date: 2018-08-01 Impact factor: 14.676
Authors: John W Scott; Pooja U Neiman; Peter A Najjar; Thomas C Tsai; Kirstin W Scott; Mark G Shrime; David M Cutler; Ali Salim; Adil H Haider Journal: J Trauma Acute Care Surg Date: 2017-05 Impact factor: 3.313
Authors: Michelle C White; Kirsten Randall; Esther Avara; Jenny Mullis; Gary Parker; Mark G Shrime Journal: World J Surg Date: 2018-05 Impact factor: 3.352
Authors: Mark G Shrime; Mirjam Hamer; Swagoto Mukhopadhyay; Lauren M Kunz; Nathan H Claus; Kirsten Randall; Joannita H Jean-Baptiste; Pierre H Maevatombo; Melissa P S Toh; Jasmin R Biddell; Ria Bos; Michelle White Journal: BMJ Glob Health Date: 2017-09-26
Authors: Glenn Douglas Guest; Elizabeth McLeod; William R G Perry; Vilami Tangi; Joao Pedro; Ponifasio Ponifasio; Johnny Hedson; Jemesa Tudravu; Douglas Pikacha; Eric Vreede; Basil Leodoro; Noah Tapaua; James Kong; Bwabwa Oten; Deacon Teapa; Stephanie Korin; Leona Wilson; Samson Mesol; Kabiri Tuneti; John G Meara; David A Watters Journal: BMJ Glob Health Date: 2017-11-25
Authors: Michelle C White; Mirjam Hamer; Jasmin Biddell; Nathan Claus; Kirsten Randall; Dennis Alcorn; Gary Parker; Mark G Shrime Journal: BMJ Glob Health Date: 2017-09-29