Financial risk of emergency abdominal surgery: a cross sectional study from Ethiopia
Abstract Background The Lancet Commission on Global Surgery suggested six indicators every country should use to measure their surgical systems. One of these indicators, catastrophic expenditure (CE), is defined as money paid for service which amounts to more than 10% of the patient’s total annual e...
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-022-08480-7 |
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| author | Abraham Genetu Demmelash Gezahegn Hana Getachew Andualem Deneke Abebe Bekele |
| author_facet | Abraham Genetu Demmelash Gezahegn Hana Getachew Andualem Deneke Abebe Bekele |
| author_sort | Abraham Genetu |
| collection | DOAJ |
| description | Abstract Background The Lancet Commission on Global Surgery suggested six indicators every country should use to measure their surgical systems. One of these indicators, catastrophic expenditure (CE), is defined as money paid for service which amounts to more than 10% of the patient’s total annual expenditure, or more than 40% of annual non-food household expenditure. Ethiopian Ministry of Health has set a target of 100% protection from CE by 2030. However, so far there is lack of studies that assess financial risk of surgery. Methods Using a cross sectional study design, financial risk assessment was carried out on 142 patients from Yekatit 12 and Zewditu Memorial hospitals in Addis Ababa, Ethiopia from May 15 to September 15, 2021. Results Appendectomy (69.0%), emergency laparotomy (26.1%) and cholecystectomy (4.9%) resulted in mean direct medical expenditures of 111.7USD, 200.70USD and 224.60USD, respectively. Medications and imaging accounted for 60.8 and 13.9% of total treatment cost. By applying the two definitions of catastrophic expenditure, 67.6 and 62.7% of patients sustained CE, respectively Overall rates of CE across procedures were 67.3 and 59.1% for appendectomy, 70.2 and 70.2% for laparotomy, 57.0 and 71.2% for cholecystectomy. Thirty-five (24.6%) patients had some form of insurance, with Community Based Health Insurance being the most common form (57%). Insured patients were less likely to sustain CE with both definitions (AOR 0.09, p = 0.002 and AOR 0.10, p = 0.006 respectively). Conclusion and recommendations Substantial proportion of patients undergoing emergency abdominal surgery sustain CE in Addis Ababa. Medications and imaging take major share of total cost mainly because patients have to acquire them from private set ups. Policy makers should work on availing medications and imaging in public hospitals as well as expand insurance and other forms of surgical care financing to protect patients from CE. |
| first_indexed | 2024-04-11T14:27:15Z |
| format | Article |
| id | doaj.art-6f39e6204bf541ec8212844c26eae870 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-11T14:27:15Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-6f39e6204bf541ec8212844c26eae8702022-12-22T04:18:48ZengBMCBMC Health Services Research1472-69632022-08-012211910.1186/s12913-022-08480-7Financial risk of emergency abdominal surgery: a cross sectional study from EthiopiaAbraham Genetu0Demmelash Gezahegn1Hana Getachew2Andualem Deneke3Abebe Bekele4College of Health Sciences, Addis Ababa UniversityCollege of Health Sciences, Addis Ababa UniversitySt Paul’s Millennium Medical CollegeCollege of Health Sciences, Addis Ababa UniversityCollege of Health Sciences, Addis Ababa UniversityAbstract Background The Lancet Commission on Global Surgery suggested six indicators every country should use to measure their surgical systems. One of these indicators, catastrophic expenditure (CE), is defined as money paid for service which amounts to more than 10% of the patient’s total annual expenditure, or more than 40% of annual non-food household expenditure. Ethiopian Ministry of Health has set a target of 100% protection from CE by 2030. However, so far there is lack of studies that assess financial risk of surgery. Methods Using a cross sectional study design, financial risk assessment was carried out on 142 patients from Yekatit 12 and Zewditu Memorial hospitals in Addis Ababa, Ethiopia from May 15 to September 15, 2021. Results Appendectomy (69.0%), emergency laparotomy (26.1%) and cholecystectomy (4.9%) resulted in mean direct medical expenditures of 111.7USD, 200.70USD and 224.60USD, respectively. Medications and imaging accounted for 60.8 and 13.9% of total treatment cost. By applying the two definitions of catastrophic expenditure, 67.6 and 62.7% of patients sustained CE, respectively Overall rates of CE across procedures were 67.3 and 59.1% for appendectomy, 70.2 and 70.2% for laparotomy, 57.0 and 71.2% for cholecystectomy. Thirty-five (24.6%) patients had some form of insurance, with Community Based Health Insurance being the most common form (57%). Insured patients were less likely to sustain CE with both definitions (AOR 0.09, p = 0.002 and AOR 0.10, p = 0.006 respectively). Conclusion and recommendations Substantial proportion of patients undergoing emergency abdominal surgery sustain CE in Addis Ababa. Medications and imaging take major share of total cost mainly because patients have to acquire them from private set ups. Policy makers should work on availing medications and imaging in public hospitals as well as expand insurance and other forms of surgical care financing to protect patients from CE.https://doi.org/10.1186/s12913-022-08480-7Financial riskCatastrophic expenditureCommunity based health insuranceGlobal surgeryAccess to surgery |
| spellingShingle | Abraham Genetu Demmelash Gezahegn Hana Getachew Andualem Deneke Abebe Bekele Financial risk of emergency abdominal surgery: a cross sectional study from Ethiopia BMC Health Services Research Financial risk Catastrophic expenditure Community based health insurance Global surgery Access to surgery |
| title | Financial risk of emergency abdominal surgery: a cross sectional study from Ethiopia |
| title_full | Financial risk of emergency abdominal surgery: a cross sectional study from Ethiopia |
| title_fullStr | Financial risk of emergency abdominal surgery: a cross sectional study from Ethiopia |
| title_full_unstemmed | Financial risk of emergency abdominal surgery: a cross sectional study from Ethiopia |
| title_short | Financial risk of emergency abdominal surgery: a cross sectional study from Ethiopia |
| title_sort | financial risk of emergency abdominal surgery a cross sectional study from ethiopia |
| topic | Financial risk Catastrophic expenditure Community based health insurance Global surgery Access to surgery |
| url | https://doi.org/10.1186/s12913-022-08480-7 |
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