Ava Yap1, Maija Cheung2, Nasser Kakembo3, Phyllis Kisa3, Arlene Muzira3, John Sekabira3, Doruk Ozgediz2. 1. Department of Surgery, University of California San Francisco, San Francisco, California. Electronic address: ava.yap@ucsf.edu. 2. Department of Surgery, Yale University School of Medicine, New Haven, Connecticut. 3. Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda.
Abstract
BACKGROUND: Financial protection from catastrophic health care expenditure (CHE) and patient out-of-pocket (OOP) spending are key indicators for sustainable surgical delivery. We aimed to calculate these metrics for a hospital stay requiring surgery in Uganda's pediatric population. METHODS: A survey was administered to family members of postoperative patients in the pediatric surgical ward at Mulago Hospital. Cost categories included direct medical costs, direct nonmedical costs, indirect costs, plus money borrowed and items sold to pay for the hospital stay. CHE was defined as spending greater than 10% of annual household expenditure. Costs were reported in Ugandan shillings and US dollars. RESULTS: One hundred and thirty-two patient families were surveyed between November 2016 and April 2017. Median direct costs were $27.55 (IQR 18.73-183.69) for diagnostics, $18.36 (IQR 9.52-41.33) for medications, $26.63 (IQR 9.19-45.92) for transportation, and $32.60 (IQR 12.85-64.29) for food and lodging. Forty-four percent of respondents were employed, and median indirect cost from productivity loss was $95.52 (IQR 55.10-243.38). Eighteen percent (16/87) borrowed money, and 9% (8/87) sold possessions to pay for the hospital stay. Total median OOP cost for patient families per hospital stay was $150.62 (IQR 65.21-339.82). Sixteen percent (21/132) of families incurred CHE from direct costs, and the proportion rose to 27% (32/132) when indirect cost was included. CONCLUSIONS: Although pediatric surgical services in Uganda are formally provided for free by the public sector, families accrue substantial OOP expenditure and almost a third of households incur CHE for a pediatric surgical procedure. This study suggests that broader financial protection must be established to meet Sustainable Development Goal targets.
BACKGROUND: Financial protection from catastrophic health care expenditure (CHE) and patient out-of-pocket (OOP) spending are key indicators for sustainable surgical delivery. We aimed to calculate these metrics for a hospital stay requiring surgery in Uganda's pediatric population. METHODS: A survey was administered to family members of postoperative patients in the pediatric surgical ward at Mulago Hospital. Cost categories included direct medical costs, direct nonmedical costs, indirect costs, plus money borrowed and items sold to pay for the hospital stay. CHE was defined as spending greater than 10% of annual household expenditure. Costs were reported in Ugandan shillings and US dollars. RESULTS: One hundred and thirty-two patient families were surveyed between November 2016 and April 2017. Median direct costs were $27.55 (IQR 18.73-183.69) for diagnostics, $18.36 (IQR 9.52-41.33) for medications, $26.63 (IQR 9.19-45.92) for transportation, and $32.60 (IQR 12.85-64.29) for food and lodging. Forty-four percent of respondents were employed, and median indirect cost from productivity loss was $95.52 (IQR 55.10-243.38). Eighteen percent (16/87) borrowed money, and 9% (8/87) sold possessions to pay for the hospital stay. Total median OOP cost for patient families per hospital stay was $150.62 (IQR 65.21-339.82). Sixteen percent (21/132) of families incurred CHE from direct costs, and the proportion rose to 27% (32/132) when indirect cost was included. CONCLUSIONS: Although pediatric surgical services in Uganda are formally provided for free by the public sector, families accrue substantial OOP expenditure and almost a third of households incur CHE for a pediatric surgical procedure. This study suggests that broader financial protection must be established to meet Sustainable Development Goal targets.
Authors: Norma E Farrow; Sarah J Commander; Christopher R Reed; Jenna L Mueller; Aryaman Gupta; Amos H P Loh; John Sekabira; Tamara N Fitzgerald Journal: Surg Endosc Date: 2020-11-17 Impact factor: 4.584
Authors: Ava Yap; Maija Cheung; Arlene Muzira; James Healy; Nasser Kakembo; Phyllis Kisa; David Cunningham; George Youngson; John Sekabira; Reza Yaesoubi; Doruk Ozgediz Journal: Ann Surg Date: 2021-02-01 Impact factor: 13.787
Authors: Leon Bijlmakers; Maike Wientjes; Gerald Mwapasa; Dennis Cornelissen; Eric Borgstein; Henk Broekhuizen; Ruairi Brugha; Jakub Gajewski Journal: Ann Med Surg (Lond) Date: 2019-06-11
Authors: Manraj Phull; Caris E Grimes; Thaim B Kamara; Haja Wurie; Andy J M Leather; Justine Davies Journal: BMJ Open Date: 2021-03-08 Impact factor: 2.692