Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda
Abstract Background The implementation of community-based health insurance in (CBHI) in Rwanda has reduced out of pocket (OOP) spending for the > 79% of citizens who enroll in it but the effect for surgical patients is not well described. For all but the poorest citizens who are completely subsid...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-022-08101-3 |
| _version_ | 1818532646647496704 |
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| author | Rachel Koch Theoneste Nkurunziza Niclas Rudolfson Jonathan Nkurunziza Laban Bakorimana Holly Irasubiza Kristin Sonderman Robert Riviello Bethany L. Hedt-Gauthier Mark Shrime Fredrick Kateera |
| author_facet | Rachel Koch Theoneste Nkurunziza Niclas Rudolfson Jonathan Nkurunziza Laban Bakorimana Holly Irasubiza Kristin Sonderman Robert Riviello Bethany L. Hedt-Gauthier Mark Shrime Fredrick Kateera |
| author_sort | Rachel Koch |
| collection | DOAJ |
| description | Abstract Background The implementation of community-based health insurance in (CBHI) in Rwanda has reduced out of pocket (OOP) spending for the > 79% of citizens who enroll in it but the effect for surgical patients is not well described. For all but the poorest citizens who are completely subsidized, the OOP (out of pocket) payment at time of service is 10%. However, 55.5% of the population is below the international poverty line meaning that even this copay can have a significant impact on a family’s financial health. The aim of this study was to estimate the burden of OOP payments for cesarean sections in the context of CBHI and determine if having it reduces catastrophic health expenditure (CHE). Methods This study is nested in a larger randomized controlled trial of women undergoing cesarean section at a district hospital in Rwanda. Eligible patients were surveyed at discharge to quantify household income and routine monthly expenditures and direct and indirect spending related to the hospitalization. This was used in conjunction with hospital billing records to calculate the rate of catastrophic expenditure by insurance group. Results About 94% of the 340 women met the World Bank definition of extreme poverty. Of the 330 (97.1%) with any type of health insurance, the majority (n = 310, 91.2%) have CBHI. The average OOP expenditure for a cesarean section and hospitalization was $9.36. The average cost adding transportation to the hospital was $19.29. 164 (48.2%) had to borrow money and 43 (12.7%) had to sell possessions. The hospital bill alone was a CHE for 5.3% of patients. However, when including transportation costs, 15.4% incurred a CHE and including lost wages, 22.6%. Conclusion To ensure universal health coverage (UHC), essential surgical care must be affordable. Despite enrollment in universal health insurance, cesarean section still impoverishes households in rural Rwanda, the majority of whom already lie below the poverty line. Although CBHI protects against CHE from the cost of healthcare, when adding in the cost of transportation, lost wages and caregivers, cesarean section is still often a catastrophic financial event. Further innovation in financial risk protection is needed to provide equitable UHC. |
| first_indexed | 2024-12-11T17:48:15Z |
| format | Article |
| id | doaj.art-6b5561b60ddc40f2ac5dfa553570140f |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-11T17:48:15Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-6b5561b60ddc40f2ac5dfa553570140f2022-12-22T00:56:18ZengBMCBMC Health Services Research1472-69632022-05-0122111110.1186/s12913-022-08101-3Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in RwandaRachel Koch0Theoneste Nkurunziza1Niclas Rudolfson2Jonathan Nkurunziza3Laban Bakorimana4Holly Irasubiza5Kristin Sonderman6Robert Riviello7Bethany L. Hedt-Gauthier8Mark Shrime9Fredrick Kateera10Program in Global Surgery and Social Change, Harvard Medical SchoolDepartment for Sport and Health Sciences, Epidemiology, Technical University of MunichProgram in Global Surgery and Social Change, Harvard Medical SchoolPartners In Health/Inshuti Mu BuzimaPartners In Health/Inshuti Mu BuzimaPartners In Health/Inshuti Mu BuzimaProgram in Global Surgery and Social Change, Harvard Medical SchoolProgram in Global Surgery and Social Change, Harvard Medical SchoolProgram in Global Surgery and Social Change, Harvard Medical SchoolProgram in Global Surgery and Social Change, Harvard Medical SchoolPartners In Health/Inshuti Mu BuzimaAbstract Background The implementation of community-based health insurance in (CBHI) in Rwanda has reduced out of pocket (OOP) spending for the > 79% of citizens who enroll in it but the effect for surgical patients is not well described. For all but the poorest citizens who are completely subsidized, the OOP (out of pocket) payment at time of service is 10%. However, 55.5% of the population is below the international poverty line meaning that even this copay can have a significant impact on a family’s financial health. The aim of this study was to estimate the burden of OOP payments for cesarean sections in the context of CBHI and determine if having it reduces catastrophic health expenditure (CHE). Methods This study is nested in a larger randomized controlled trial of women undergoing cesarean section at a district hospital in Rwanda. Eligible patients were surveyed at discharge to quantify household income and routine monthly expenditures and direct and indirect spending related to the hospitalization. This was used in conjunction with hospital billing records to calculate the rate of catastrophic expenditure by insurance group. Results About 94% of the 340 women met the World Bank definition of extreme poverty. Of the 330 (97.1%) with any type of health insurance, the majority (n = 310, 91.2%) have CBHI. The average OOP expenditure for a cesarean section and hospitalization was $9.36. The average cost adding transportation to the hospital was $19.29. 164 (48.2%) had to borrow money and 43 (12.7%) had to sell possessions. The hospital bill alone was a CHE for 5.3% of patients. However, when including transportation costs, 15.4% incurred a CHE and including lost wages, 22.6%. Conclusion To ensure universal health coverage (UHC), essential surgical care must be affordable. Despite enrollment in universal health insurance, cesarean section still impoverishes households in rural Rwanda, the majority of whom already lie below the poverty line. Although CBHI protects against CHE from the cost of healthcare, when adding in the cost of transportation, lost wages and caregivers, cesarean section is still often a catastrophic financial event. Further innovation in financial risk protection is needed to provide equitable UHC.https://doi.org/10.1186/s12913-022-08101-3Developing countriesEconomic crisisHealth care reformHealth financingMaternity servicesPolicy evaluation |
| spellingShingle | Rachel Koch Theoneste Nkurunziza Niclas Rudolfson Jonathan Nkurunziza Laban Bakorimana Holly Irasubiza Kristin Sonderman Robert Riviello Bethany L. Hedt-Gauthier Mark Shrime Fredrick Kateera Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda BMC Health Services Research Developing countries Economic crisis Health care reform Health financing Maternity services Policy evaluation |
| title | Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda |
| title_full | Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda |
| title_fullStr | Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda |
| title_full_unstemmed | Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda |
| title_short | Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda |
| title_sort | does community based health insurance protect women from financial catastrophe after cesarean section a prospective study from a rural hospital in rwanda |
| topic | Developing countries Economic crisis Health care reform Health financing Maternity services Policy evaluation |
| url | https://doi.org/10.1186/s12913-022-08101-3 |
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