What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure

Research output: Contribution to journalArticlepeer-review

Standard

What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure. / Phull , Manraj ; Grimes, Caris E; Kamara, Thaim B; Wurie, Haja ; Leather, Andrew J M; Davies, Justine.

In: British Medical Journal Open, Vol. 11, No. 3, e039049, 08.03.2021.

Research output: Contribution to journalArticlepeer-review

Harvard

APA

Vancouver

Author

Bibtex

@article{34dbf26d09244d2e92bcdc4b9897aea9,
title = "What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure",
abstract = "Objectives: To measure the financial burden associated with accessing surgical care in Sierra Leone. Design: A cross-sectional survey conducted with patients at the time of discharge from tertiary level care. This captured demographics, yearly household expenditure, direct medical, direct non-medical, and indirect costs for surgical care, and summary household assets. Missing data were imputed.Setting: The main tertiary level hospital in Freetown, Sierra Leone. Participants: 335 surgical patients under the care of the hospital surgical team receiving operative or non-operative surgical care on the surgical wards.Outcome measures: Rates of catastrophic expenditure (CE) (a cost > 10% of annual expenditure), impoverishment (being pushed into, or further into, poverty as a result of surgical care costs), amount of out-of-pocket (OOP) costs, and means used to meet these costs were derived. Results: Of 335 patients interviewed, 39% were female and 80% were urban dwellers. Median yearly household expenditure was US$3569. Mean OOP costs were US$243, of which a mean of US$24 (10%) was spent pre-hospital. Of costs incurred during the hospital admission, direct medical costs were US$138 (63%) and US$34 (16%) were direct non-medical costs. US$46 (21%) were indirect costs. Catastrophic expenditure affected 18% of those interviewed. Concerning impoverishment, 45% of patients were already below the national poverty line prior to admission, and 9% of those who were not were pushed below the poverty line following payment for surgical care. 84% of patients used household savings to meet OOP costs. Only 2% (6 patients) had health insurance. Conclusion: Obtaining surgical care has substantial economic impacts on households which pushes them into poverty or further into poverty. The much-needed scaling up of surgical care needs to be accompanied by financial risk protection. ",
author = "Manraj Phull and Grimes, {Caris E} and Kamara, {Thaim B} and Haja Wurie and Leather, {Andrew J M} and Justine Davies",
year = "2021",
month = mar,
day = "8",
doi = "10.1136/bmjopen-2020-039049",
language = "English",
volume = "11",
journal = "BMJ open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "3",

}

RIS

TY - JOUR

T1 - What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure

AU - Phull , Manraj

AU - Grimes, Caris E

AU - Kamara, Thaim B

AU - Wurie, Haja

AU - Leather, Andrew J M

AU - Davies, Justine

PY - 2021/3/8

Y1 - 2021/3/8

N2 - Objectives: To measure the financial burden associated with accessing surgical care in Sierra Leone. Design: A cross-sectional survey conducted with patients at the time of discharge from tertiary level care. This captured demographics, yearly household expenditure, direct medical, direct non-medical, and indirect costs for surgical care, and summary household assets. Missing data were imputed.Setting: The main tertiary level hospital in Freetown, Sierra Leone. Participants: 335 surgical patients under the care of the hospital surgical team receiving operative or non-operative surgical care on the surgical wards.Outcome measures: Rates of catastrophic expenditure (CE) (a cost > 10% of annual expenditure), impoverishment (being pushed into, or further into, poverty as a result of surgical care costs), amount of out-of-pocket (OOP) costs, and means used to meet these costs were derived. Results: Of 335 patients interviewed, 39% were female and 80% were urban dwellers. Median yearly household expenditure was US$3569. Mean OOP costs were US$243, of which a mean of US$24 (10%) was spent pre-hospital. Of costs incurred during the hospital admission, direct medical costs were US$138 (63%) and US$34 (16%) were direct non-medical costs. US$46 (21%) were indirect costs. Catastrophic expenditure affected 18% of those interviewed. Concerning impoverishment, 45% of patients were already below the national poverty line prior to admission, and 9% of those who were not were pushed below the poverty line following payment for surgical care. 84% of patients used household savings to meet OOP costs. Only 2% (6 patients) had health insurance. Conclusion: Obtaining surgical care has substantial economic impacts on households which pushes them into poverty or further into poverty. The much-needed scaling up of surgical care needs to be accompanied by financial risk protection. 

AB - Objectives: To measure the financial burden associated with accessing surgical care in Sierra Leone. Design: A cross-sectional survey conducted with patients at the time of discharge from tertiary level care. This captured demographics, yearly household expenditure, direct medical, direct non-medical, and indirect costs for surgical care, and summary household assets. Missing data were imputed.Setting: The main tertiary level hospital in Freetown, Sierra Leone. Participants: 335 surgical patients under the care of the hospital surgical team receiving operative or non-operative surgical care on the surgical wards.Outcome measures: Rates of catastrophic expenditure (CE) (a cost > 10% of annual expenditure), impoverishment (being pushed into, or further into, poverty as a result of surgical care costs), amount of out-of-pocket (OOP) costs, and means used to meet these costs were derived. Results: Of 335 patients interviewed, 39% were female and 80% were urban dwellers. Median yearly household expenditure was US$3569. Mean OOP costs were US$243, of which a mean of US$24 (10%) was spent pre-hospital. Of costs incurred during the hospital admission, direct medical costs were US$138 (63%) and US$34 (16%) were direct non-medical costs. US$46 (21%) were indirect costs. Catastrophic expenditure affected 18% of those interviewed. Concerning impoverishment, 45% of patients were already below the national poverty line prior to admission, and 9% of those who were not were pushed below the poverty line following payment for surgical care. 84% of patients used household savings to meet OOP costs. Only 2% (6 patients) had health insurance. Conclusion: Obtaining surgical care has substantial economic impacts on households which pushes them into poverty or further into poverty. The much-needed scaling up of surgical care needs to be accompanied by financial risk protection. 

U2 - 10.1136/bmjopen-2020-039049

DO - 10.1136/bmjopen-2020-039049

M3 - Article

VL - 11

JO - BMJ open

JF - BMJ open

SN - 2044-6055

IS - 3

M1 - e039049

ER -