Cost of Treating Maternal Complications and Associated Factors in Mekelle General Hospital, Northern Ethiopia

Abadi, Teamir; Mebratie, Anagaw Derseh

doi:10.2147/rmhp.s285793

Cited by 7 publications

(27 citation statements)

References 21 publications

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“…All surgical care is considered free in Malawi and Uganda, and in Madagascar there is a form of insurance for the poor [37]. In Ethiopia, surgical services are based on payments at the point of care, with the exception of obstetric services which are meant to be provided free of charge through the exemption programme [9, 40, 41]. Beyond these differences in healthcare financial strategies across countries, it is likely that the proportion of those in need of surgical care who even manage to access hospital care may vary, expected to be lower in this rural, low-income Ethiopian setting.…”

Section: Discussionmentioning

confidence: 99%

Costs, catastrophic out-of-pocket payments and impoverishment related to accessing surgical care among households in rural Ethiopia

Hailemichael,

Eshetu,

Timothewos

et al. 2023

Preprint

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BackgroundThe objective of this study was to assess the costs, catastrophic out-of-pocket (OOP) health expenditure, impoverishment and coping mechanisms used to pay for surgical care in a predominantly rural area of Ethiopia.MethodsWe conducted a community-based, cross-sectional household survey of 182 people who had undergone a surgical procedure. Participants were interviewed in their homes at six weeks post-operation. Using a contextually adapted version of the Study of global AGEing and adult health (SAGE) questionnaire, we estimated direct and indirect costs of surgical care from a household perspective. Catastrophic out-of-pocket (OOP) health expenditure was estimated using thresholds of 10% and 25% of annual household consumption expenditure. Impacts of surgical care payments on poverty levels was estimated by comparing pre-and post-operative OOP payments. Analysis of variance, t-test and a logit model were used to assess factors associated with catastrophic OOP health expenditure.ResultsMost surgical patients were women (87.9%), with 65% receiving obstetric surgical care. Direct costs dominated expenditure: direct medical costs Birr 1649.5 (44.6%), direct non-medical costs Birr 1226.5 (33.2%), indirect costs Birr 821.9 (22.2%). Catastrophic OOP surgical care expenditure was experienced by 69.2% households at the 10% threshold and 45.6% at the 25% threshold. The increase in average normalized poverty gap due to OOP surgical care expenditure was higher in non-obstetric (14.1%) compared to obstetric (5.8%) procedures, and for non-emergency (13.3%) compared to emergency care (6.3%). To pay for surgical care, 38% of households had sold assets and 5% had borrowed money.ConclusionsDue to surgical care, households faced severe financial burdens leading to impoverishment. Households implemented hardship coping strategies to mitigate the financial constraints. Provision of free maternal care reduced but did not eliminate these burdens. There is a pressing need to tailor financial risk protection mechanisms to achieve universal coverage for surgical care.

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Section: Discussionmentioning

confidence: 99%

Costs, catastrophic out-of-pocket payments and impoverishment related to accessing surgical care among households in rural Ethiopia

Hailemichael,

Eshetu,

Timothewos

et al. 2023

Preprint

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“…Other studies in northern Ethiopia and Nigeria support this study, which found that the cost of a patient's complication was higher for mother who requested more laboratory tests. 7,10 The possible reasons for this might be due to the mothers were paying for laboratory when they go outside of the hospitals as well as for transportations of the sample. When compared to patients who did not miss work due to a complication, patients who missed work increased the cost of complications.…”

Section: Discussionmentioning

confidence: 99%

“…Poor care quality is also associated with high rates of morbidity, death, and the expense of maternal complications. 7 Obstetric hemorrhage, sepsis, anemia, hypertensive disorders of pregnancy, and dystocia (obstructed labor) have been identified as the main causes of maternal near-misses. 3,8 It might be challenging to use hospitalized maternal health care services due to the financial burden that maternal complications place on families.…”

Section: Introductionmentioning

confidence: 99%

“…11 A study conducted in Ethiopia found that spending on maternal complications is closely connected to poverty. 7 The cost of treating a Maternal Complication is influenced by a number of factors, including direct medical costs (registration, consultation, laboratory test, drugs, transportation, and other related expenses), nonmedical direct costs (Transportation and food), costs incurred indirectly (absenteeism), delivery method. 9,11 Ethiopia's government enacted an exemption policy that guarantees free maternity healthcare from public providers.…”

Section: Introductionmentioning

confidence: 99%

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Cost of maternal complications and its associated factors among mothers attending Hawassa public hospitals, Southern Ethiopia

Loko,

Ayele,

Dessie

et al. 2023

Journal of Public Health Research

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Background: The cost of maternal complications is considered as an important factor hindering the utilization of maternal health care services. However, information of estimate of spending on maternal complication was lacking. This study was aimed to estimate the cost of maternal complications and associated factors among mother’s attending Hawassa public hospitals, Sidama Regional state, Ethiopia. Methods: A cross-sectional study design was conducted among 348 randomly selected mothers attending public hospitals in Hawassa from November 15 to December 15, 2021. Data was coded and entered into Epi Data version 3.1 and exported to STATA version 16.0 for analysis. Simple and multiple linear regression analysis was done. Correlation coefficient along with 95% CI was used to present the finding and p < 0.05 was used to declare statistical significance. Results: This study found that total median cost of maternal complications was 4895.5 (IQR = 3779) ETB. The total median direct medical cost was 1765.5 (IQR = 1649.5) ETB. Number of days absent [( R = 0.028; 95% CI: (0.023, 0.033)], distance from facility [( R = 0.001; 95% CI: (0.000, 0.002)], site of laboratory diagnosis [( R = 0.230; 95% CI: (0.140, 0.320)], number of laboratory test conducted [( R = 0.045; 95% CI: (0.021, 0.069)] were found to be significance predictors of maternal complications costs. Conclusions: Total median cost of maternal complications in current study was high. Respondents’ site of diagnosis, number of days missed from work, number of laboratory tests, and distance from hospitals were independent predictors of maternal complications cost. Thus, we will recommend governments to introduce strategies that specifically help mothers with maternal complications.

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“…The tripling of out of pocket expenditures by follow-up costs implies that the full nancial picture of c-section care can only be truly understood when post-discharge costs are examined. Most costs covered by health insurance globally are expenditures linked to direct medical services [34][35][36], but this misses the substantial follow-up costs. For example, despite full coverage of direct medical cost for people in Ubudehe 1, the incidence of CHE in this group within 30 days post-cesarean was 74.0%.…”

Section: Discussionmentioning

confidence: 99%

The True Costs of Cesarean Sections for Patients in Rural Rwanda: Accounting for Post-Discharge Expenses in Estimated Health Expenditures

Niyigena¹,

Alayande²,

Bikorimana³

et al. 2021

Preprint

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Introduction: While it is recognized that there are costs associated with postoperative patient follow-up, risk assessments of catastrophic health expenditures (CHEs) due to surgery in sub-Saharan Africa rarely include expenses after discharge. We describe patient-level costs for cesarean section (c-section) and follow-up care up to postoperative day (POD) 30 and evaluate the contribution of follow-up to CHEs in rural Rwanda.Methods: We interviewed women who delivered via c-section at Kirehe District Hospital between September 2019 and February 2020. Expenditure details were captured on an adapted surgical indicator financial survey tool and extracted from the hospital billing system. CHE was defined as health expenditure of ≥ 10% of annual household expenditure. We report the cost of c-section up to 30 days after discharge, the rate of CHE among c-section patients stratified by in-hospital costs and post-discharge follow-up costs, and the main contributors to c-section follow-up costs. Results: Of the 479 participants in this study, 90% were classified as impoverished before surgery and an additional 6.4% were impoverished by the c-section. The median out-of-pocket costs up to POD30 was US$122.16 (IQR: $102.94, $148.11); 63% of these expenditures were attributed to post-discharge expenses or lost opportunity costs (US$77.50; IQR: $67.70, $95.60). To afford c-section care, 64.4% borrowed money and 18.4% sold possessions. The CHE rate was 27% when only considering direct and indirect costs up to the time of discharge and 77% when including the reported expenses up to POD30. Transportation and lost household wages were the largest contributors to post-discharge costs. Conclusion: Costs associated with surgical follow-up are often neglected in financial risk calculations but contribute significantly to the risk of CHE in rural Rwanda. Insurance coverage for direct medical costs is insufficient to protect against CHE. Innovative follow-up solutions to reduce costs of patient transport and compensate for household lost wages need to be considered.

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Cost of Treating Maternal Complications and Associated Factors in Mekelle General Hospital, Northern Ethiopia

Cited by 7 publications

References 21 publications

Costs, catastrophic out-of-pocket payments and impoverishment related to accessing surgical care among households in rural Ethiopia

Costs, catastrophic out-of-pocket payments and impoverishment related to accessing surgical care among households in rural Ethiopia

Cost of maternal complications and its associated factors among mothers attending Hawassa public hospitals, Southern Ethiopia

The True Costs of Cesarean Sections for Patients in Rural Rwanda: Accounting for Post-Discharge Expenses in Estimated Health Expenditures

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