Catastrophic expenditure to pay for surgery worldwide: a modelling study

Abstract

Purpose Approximately 150 million individuals face catastrophic expenditure each year from medical costs alone, and many more from the nonmedical costs of accessing care. The proportion of this expenditure arising from surgical conditions is unknown. Because World Bank has proposed eliminating medical impoverishment by 2030, the impact of surgical conditions on financial catastrophe must be quantified so that any financial risk protection mechanisms can appropriately incorporate surgery. Methods To determine the global incidence of catastrophic expenditure due to surgery, a stochastic model was built. The income distribution of each country, the probability of requiring surgery, and the medical and nonmedical costs faced for surgery were incorporated. Sensitivity analyses were run to test model robustness. Findings 3.7 billion people risk catastrophic expenditure if they need surgery. Every year, 33 million of them are driven to financial catastrophe from the costs of surgery alone, and 48 million from nonmedical costs, leading to 81 million cases worldwide. The burden of catastrophic expenditure is highest in low- and middle-income countries; within any country, it falls on the poor. Estimates are sensitive to the definition of catastrophic expenditure and the costs of care. The inequitable burden distribution is robust to model assumptions. Interpretation Half the global population is at risk of financial catastrophe from surgery. Annually, 81 million individuals, especially the poor, face catastrophic expenditure due to surgical conditions, of which less than half is attributable to medical costs. These findings highlight the need for financial risk protection for surgery in health system design. Funding Partial funding for Dr. Shrime from NIH/NCI R25CA92203.

Measuring Financial Protection in Hospitalized Patients after the Health Sector Evolution Plan in Iran

“…A modeling study on catastrophic expenditure to pay for surgery worldwide showed that each year, approximately 33 million people worldwide suffer from catastrophic expenditure due to surgical care and almost 3.7 billion people will experience catastrophic payment if they undergo surgery treatments (2). A study by Nguyen et al in Vietnam, on surgical cost and catastrophic expenditure among hospitalized patients with injuries, showed a substantial financial burden of households due to surgery.…”

“…As a result, the concept of financial risk protection remains a major focus of many health systems (2,3) and is a core component of universal health coverage (UHC) (1). Financial protection is defined as access to needed and good quality health services without financial catastrophe.…”

Pro: Pure service delivery is still needed in global surgery missions

“…3 Cette diversité rend complexe toute évaluation ou comparaison. • Chaque année, 81 millions de personnes sont confrontées à une ruine financière catastrophique en raison des coûts associés à la chirurgie et à l'anesthésie Pro: Pure service delivery is still needed in global surgery missions 349 et aux coûts non médicaux associés à l'accès aux soins, tels que le transport; 5 • Environ 28-32 % du fardeau mondial de la maladie est attribuable à des maladies traitables grâce à une chirurgie. 6 En outre, au cours des 15 prochaines années, on projette que les besoins pour des services chirurgicaux dans les pays à revenu faible à intermédiaire vont augmenter en raison de l'incidence accrue de cancers, d'accidents de la route, et de maladies cardiovasculaires et métaboliques.…”

Lancet Commission on Global Surgery

“…Access to care is defined as the proportion of the population that can access a facility capable of performing bellwether procedures (cesarean sections, exploratory laparotomy, and treatment of open fractures) (2). The definition was derived by evaluating the four dimensions of access which include timeliness, surgical capacity, safety and affordability (9)(10)(11)(12). It is estimated that nearly 70% of the global population currently cannot access the surgical treatment they need (2).…”