New infographic by Dr. Jose Campos and the Chilean Society of Pediatric Surgery
"Out-of-pocket costs and catastrophic healthcare expenditure for families of children requiring surgery in sub-Saharan Africa"
Authos: Ava Yap MD, MHS, Bolusefe T. Olatunji MD, Samuel Negash MD, Dilon Mweru MD, Steve Kisembo MD, Franck Masumbuko MD, Emmanuel A. Ameh MD, Aiah Lebbie MD, Bruce Bvulani MD, Eric Hansen MD, Godfrey Sama Philipo MD, Madeleine Carroll MD, Phillip J. Hsu MD, PhD, Emma Bryce MPH, Maija Cheung MD, Maira Fedatto PhD, Ruth Laverde BS, Doruk Ozgediz MD, MPH
Full article: https://gcmd.co/3Pyd8vh
Background
Out-of-pocket healthcare costs leading to catastrophic healthcare expenditure pose a financial threat for families of children undergoing surgery in Sub-Saharan African countries, where universal healthcare coverage is often insufficient.
Methods
A prospective clinical and socioeconomic data collection tool was used in African hospitals with dedicated pediatric operating rooms installed philanthropically. Clinical data were collected via chart review and socioeconomic data from families. The primary indicator of economic burden was the proportion of families with catastrophic healthcare expenditures. Secondary indicators included the percentage who borrowed money, sold possessions, forfeited wages, and lost a job secondary to their child’s surgery. Descriptive statistics and multivariate logistic regression were performed to identify predictors of catastrophic healthcare expenditure.
Results
In all, 2,296 families of pediatric surgical patients from 6 countries were included. The median annual income was $1,000 (interquartile range 308–2,563), whereas the median out-of-pocket cost was $60 (interquartile range 26–174). Overall, 39.9% (n = 915) families incurred catastrophic healthcare expenditure, 23.3% (n = 533) borrowed money, 3.8% (n = 88%) sold possessions, 26.4% (n = 604) forfeited wages, and 2.3% (n = 52) lost a job because of the child’s surgery. Catastrophic healthcare expenditure was associated with older age, emergency cases, need for transfusion, reoperation, antibiotics, and longer length of stay, whereas the subgroup analysis found insurance to be protective (odds ratio 0.22, P = .002).
Conclusion
A full 40% of families of children in sub-Saharan Africa who undergo surgery incur catastrophic healthcare expenditure, shouldering economic consequences such as forfeited wages and debt. Intensive resource utilization and reduced insurance coverage in older children may contribute to a higher likelihood of catastrophic healthcare expenditure and can be insurance targets for policymakers.
