Out-of-Pocket and Catastrophic Expenses Incurred by Seeking Pediatric and Adult Surgical Care at a Public, Tertiary Care Centre in Uganda
- 137 Downloads
Surgical care is critical to establish effective healthcare systems in low- and middle-income countries, yet the unmet need for surgical conditions is as high as 65% in Ugandan children. Financial burden and geographical distance are common barriers to help-seeking in adult populations and are unmeasured in the pediatric population. We thus measured out-of-pocket (OOP) expenses and distance traveled for pediatric surgical care in a tertiary hospital in Mbarara, Uganda, as compared to adult surgical and pediatric medical patients.
Patients admitted to pediatric surgical (n = 20), pediatric medical (n = 18) and adult surgical (n = 18) wards were interviewed upon discharge over a period of 3 weeks. Patient and caregiver-reported expenses incurred for the present illness included prior/future care needed, and travel distance/cost. The prevalence of catastrophic expenses (≥10% of annual income) was calculated and spending patterns compared between wards.
Thirty-five percent of pediatric medical patients, 45% of pediatric surgical patients and 55% of adult surgical patients incurred catastrophic expenses. Pediatric surgical patients paid more for their current treatment (p < 0.01)—specifically medications (p < 0.01) and tests (p < 0.01)—than pediatric medical patients, and comparable costs to adults. Adult patients paid more for treatment prior to the hospital (p = 0.04) and miscellaneous expenses (e.g., food while admitted) (p = 0.02). Patients in all wards traveled comparable distances.
Seeking healthcare at a publicly funded hospital is financially catastrophic for almost half of patients. Out-of-stock supplies and broken equipment make surgical care particularly vulnerable to OOP expenses because analgesics, anaesthesia and preoperative imaging are prerequisites to care.
Dr. Yousef and Dr. St-Louis received financial support for this work by the Fondation de Recherche Québec - Santé. Dr. Yousef received financial support from the Canadian Institute for Health Research.
Funding was provided by Global Health Student Bursary, Faculty of Medicine, McGill University.
Compliance with ethical standards
Conflict of interest
- 4.Global Surgery Map (c2015) COSECSA. [cited 2018 Jan 12]. www.cosecsa.org/global-surgery-map
- 7.Mukasa N (2012) Uganda Healthcare system profile: background, organization, polices and challenges. J Sustain Reg Health Syst 1(1):2–10Google Scholar
- 12.World Bank Group (2017) Out-of-pocket health expenditure. https://data.worldbank.org/country/uganda. Accessed 1 Sept 2017
- 14.World Health Organisation (2015) Uganda equity tool. www.equitytool.org/uganda/. Accessed 1 May 2017
- 15.Uganda Bureau of Statistics (2014) Uganda National Household Survey 2012/2013. http://www.ubos.org/onlinefiles/uploads/ubos/UNHS_12_13/2012_13%20UNHS%20Final%20Report.pdf. Accessed 15 Sept 2017
- 17.World Health Organization (2005) The elimination of user fees in Uganda: impact on utilization and catastrophic health expenditures. http://www.who.int/health_financing/documents/dp_e_05_4-user_fee_elimination_uganda.pdf. Accessed 1 Sept 2017