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 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.

Assessing Ethiopia's surgical capacity in light of global surgery 2030 initiatives: Is there progress in the past decade?

“…Furthermore, 85 % face the risk of CHE, with only 15 % protected, exemplified by direct OOP payments exceeding 10 % of the household's annual income. Similar studies estimated the risk of CHE in surgical patients was 62.7 %, indicating that 37.3 % were protected ( Table 1 ) [ 37 ].…”

“…[ 36 ] 37 % ? [ 37 ] Risk of impoverishing expenditure 100 % protection a 2 % [ 49 ] The table structure is adapted from Shirley and colleague [ 50 ]. ?…”

“…The majority of Ethiopians experience forced out-of-pocket payments, leading to 18 % skipping medical care due to financial constraints, resulting in delayed surgical interventions, leading to poor outcomes [ 46 ]. Access to surgery appears limited to those who can afford it, highlighting the need for financial support and policy interventions [ 37 ].…”

Organizational peer support to enable rehabilitating surgical services in Northern Ethiopia

“…A recent report suggested that on average patients travel 284.3 km, or 28.4 h to access services at specialized hospitals in Ethiopia [16]. Surgical patients are confronted with high rates of catastrophic expenditure due to a lack of financial risk protection, further contributing to delayed care seeking behavior [21,22] and causing a substantial unmet need (approximately 5 million people) [20], with high levels of mortality and disability linked to conditions treatable through surgery. Considering this baseline, the situation was worsened by the COVID-19 pandemic.…”

It is time to revisit and re-evaluate Africa’s sub-par emergency surgical delivery

“…An Ethiopian study found that two-thirds of emergency abdominal surgery patients could not afford their procedures. Each year, ~81.2 million patients face financial constraints, according to the Lancet Commission on Global Surgery, with Africa accounting for the majority of these figures [7] . The percentage of people in African countries who do not have enough money to pay for surgery varies, with Burundi ranking first at 91%.…”