National health insurance and surgical care for injured people, Ghana

Gyedu, Adam; Goodman, Stephanie K; Katz, Micah G.; Quansah, Robert; Stewart, Barclay T; Donkor, Peter; Mock, Charles

doi:10.2471/blt.20.255315

Cited by 7 publications

(11 citation statements)

References 26 publications

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“…In India, motorcycles represented 70% of registered vehicles in 2010 [ 26 ]. On the contrary, the majority of males and distribution of age, concentrated on young adults, are quite similar to other studies ([ 13 , 23 ]).…”

Section: Discussionsupporting

confidence: 90%

“…This is consistent with the near absence of health insurance plans in Burkina Faso, which leaves the poorest vulnerable when faced with an unexpected out-of-pocket payment. Being insured significantly reduces the probability for the expenses linked to an injury being catastrophic [ 23 ]. In Burkina Faso, the importance of socioeconomic status has already been highlighted.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings suggest that it is essential to develop protection schemes against RTI risks, following the worldwide objective of Universal Health Coverage. Health insurance lowers the probability of catastrophic expenditures when an accident occurs [ 23 ], and reduces economic inequalities faced with this risk, though it is still marginal in Burkina Faso. Most RTIs in our sample are non-severe but still represent a financial burden for households.…”

Section: Discussionmentioning

confidence: 99%

“…Even though using global household consumption as a denominator has its limits and ideally one should withdraw expenditures linked to basic needs (housing, food) from global consumption level to get the household ability-to pay [ 22 ], no disaggregation of the consumption items was available in the questionnaire so that we used the initial measure with global expenditures as denominator ([ 10 , 12 ]). The 10% threshold was retained, in line with the literature ([ 13 , 23 ]).…”

Section: Methodsmentioning

confidence: 99%

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Out-of-pocket payments and catastrophic expenditures due to traffic injuries in Ouagadougou, Burkina Faso

Petitfour¹,

Bonnet

Mathevet

et al. 2021

Health Econ Rev

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Objective To estimate the out-of-pocket expenditures linked to Road Traffic Injuries in Ouagadougou, Burkina Faso, as well as the prevalence of catastrophic expenditures among those out-of-pocket payments, and to identify the socio-economic determinants of catastrophic expenditures due to Road Traffic Injuries. Methods We surveyed every admission at the only trauma unit of Ouagadougou between January and July 2015 at the time of their admission, 7 days and 30 days later. We estimate a total amount of out-of-pocket expenditures paid by each patient. We considered an expense as catastrophic when it represented 10% at least of the annual global consumption of the patient’s household. We used linear models to determine if socio-economic characteristics were associated to a greater or smaller ratio between out-of-pocket payment and global annual consumption. Findings We surveyed 1323 Road injury victims three times (admission, Days 7 and 30). They paid in average 46,547 FCFA (83.64 US dollars) for their care, which represent a catastrophic expenditure for 19% of them. Less than 5% of the sample was covered by a health insurance scheme. Household economic status is found to be the first determinant of catastrophic health expenditure occurrence, exhibiting a significant and negative on the ratio between road injury expenditures and global consumption. Conclusion Our findings highlight the importance of developing health insurance schemes to protect poor households from the economic burden of road traffic injuries and improve equity in front of health shocks.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Out-of-pocket payments and catastrophic expenditures due to traffic injuries in Ouagadougou, Burkina Faso

Petitfour¹,

Bonnet

Mathevet

et al. 2021

Health Econ Rev

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“…The paucity of trauma data and non-uniformity within countries as illustrated above makes national comparisons difficult. This variation reflects variation in surgical capacity defined by human resources and equipment [ 131 , 132 ].…”

Section: Search Resultsmentioning

confidence: 99%

Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review

Alayande,

Chu,

Jumbam

et al. 2022

Curr Trauma Rep

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Purpose of Review Sub-Saharan Africa is a diverse context with a large burden of injury and trauma-related deaths. Relative to high-income contexts, most of the region is less mature in prehospital and facility-based trauma care, education and training, and trauma care quality assurance. The 2030 Agenda for Sustainable Development recognizes rising inequalities, both within and between countries as a deterrent to growth and development. While disparities in access to trauma care between the region and HICs are more commonly described, internal disparities are equally concerning. We performed a narrative review of internal disparities in trauma care access using a previously described conceptual model. Recent Findings A broad PubMed and EMBASE search from 2010 to 2021 restricted to 48 sub-Saharan African countries was performed. Records focused on disparities in access to trauma care were identified and mapped to de Jager’s four component framework. Search findings, input from contextual experts, comparisons based on other related research, and disaggregation of data helped inform the narrative. Only 21 studies were identified by formal search, with most focused on urban versus rural disparities in geographical access to trauma care. An additional 6 records were identified through citation searches and experts. Disparity in access to trauma care providers, detection of indications for trauma surgery, progression to trauma surgery, and quality care provision were thematically analyzed. No specific data on disparities in access to injury care for all four domains was available for more than half of the countries. From available data, socioeconomic status, geographical location, insurance, gender, and age were recognized disparity domains. South Africa has the most mature trauma systems. Across the region, high quality trauma care access is skewed towards the urban, insured, higher socioeconomic class adult. District hospitals are more poorly equipped and manned, and dedicated trauma centers, blood banks, and intensive care facilities are largely located within cities and in southern Africa. The largest geographical gaps in trauma care are presumably in central Africa, francophone West Africa, and conflict regions of East Africa. Disparities in trauma training opportunities, public–private disparities in provider availability, injury care provider migration, and several other factors contribute to this inequity. National trauma registries will play a role in internal inequity monitoring, and deliberate development implementation of National Surgical, Obstetrics, and Anesthesia plans will help address disparities. Human, systemic, and historical factors supporting these disparities including implicit and explicit bias must be clearly identified and addressed. Systems approaches, strategic trauma policy frameworks, and global and regional coalitions, as modelled by the Global Alliance for Care of the Injured and the Bellagio group, are key. Inequity in access can be reduced by prehospital initiatives, as used in Ghana, and community-based insurance, as modelled by Rwanda. Summary Sub-Saharan African countries have underdeveloped trauma systems. Consistent in the narrative is the rural-urban disparity in trauma care access and the disadvantage of the poor. Further research is needed in view of data disparity. Recognition of these disparities should drive creative equitable solutions and focused interventions, partnerships, accompaniment, and action.

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Factors Contributing to and Reducing Delays in the Provision of Adequate Care in Ghana: A Qualitative Study of Trauma Care Providers

et al. 2022

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Background Ghana has a large and growing burden of injury morbidity and mortality. There is a substantial unmet need for trauma surgery, highlighting a need to understand gaps in care. Methods We conducted 8 in-depth interviews with trauma care providers (surgeons, nurses, and specialists) at a large teaching hospital to understand factors that contribute to and reduce delays in the provision of adequate trauma care for severely injured patients. The study aimed to understand whether providers thought factors differed between patients that were enrolled in the National Health Insurance Scheme (NHIS) and those that were not. Findings were presented for the third delay (provision of appropriate care) in the Three Delays Framework.Results Key findings included that most factors contributing delays in the provision of adequate care were related to the costs of care, including for diagnostics, medications, and treatment for patients with and without NHIS subscription. Other notable factors included conflicts between providers, resource constraints, and poor coordination of care at the facility. Factors which reduce delays included advocacy by providers and informal processes for prioritizing critical injuries. ConclusionWe recommend facility-level changes including increasing equity in access to trauma and elective surgery through targeted system strengthening efforts (e.g., a scheduled back-up call system for surgeons, anesthetists, other specialists, and nurses; designated operating theatres and staff for emergencies; training of staff), policy changes to simplify the insurance renewal and subscription processes, and future research on the costs and benefits of including diagnostics, medications, and common trauma services into the NHIS benefits package.

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National health insurance and surgical care for injured people, Ghana

Cited by 7 publications

References 26 publications

Out-of-pocket payments and catastrophic expenditures due to traffic injuries in Ouagadougou, Burkina Faso

Out-of-pocket payments and catastrophic expenditures due to traffic injuries in Ouagadougou, Burkina Faso

Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review

Factors Contributing to and Reducing Delays in the Provision of Adequate Care in Ghana: A Qualitative Study of Trauma Care Providers

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