Risk of Catastrophic Health Expenditure in Rwandan Surgical Patients with Peritonitis.

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Risk of Catastrophic Health Expenditure in Rwandan Surgical Patients with Peritonitis.


JournalWorld journal of surgery
Publication date – Jun – 2018
Authors – Rickard, JL; Ngarambe, C; Ndayizeye, L; Smart, B; Majyambere, JP; Riviello, R
Keywordscatastrophic health expenditure, hospital charges, peritonitis
Open access – No
SpecialityGeneral surgery
World region Eastern Africa
Country: Rwanda
Language – English
Submitted to the One Surgery Index on July 21, 2018 at 12:00 am
Abstract:

Background
Surgical procedures are cost-effective compared with various medical and public health interventions. While peritonitis often requires surgery, little is known regarding the associated costs, particularly in low- and middle-income countries. The aim of this study was to determine in-hospital charges for patients with peritonitis and if patients are at risk of catastrophic health expenditure.

Methods
As part of a larger study examining the epidemiology and outcomes of patients with peritonitis at a referral hospital in Rwanda, patients undergoing operation for peritonitis were enrolled and hospital charges were examined. The primary outcome was the percentage of patients at risk for catastrophic health expenditure. Logistic regression was used to determine the association of various factors with risk for catastrophic health expenditure.

Results
Over a 6-month period, 280 patients underwent operation for peritonitis. In-hospital charges were available for 245 patients. A total of 240 (98%) patients had health insurance. Median total hospital charges were 308.1 USD, and the median amount paid by patients was 26.9 USD. Thirty-three (14%) patients were at risk of catastrophic health expenditure based on direct medical expenses. Estimating out-of-pocket non-medical expenses, 68 (28%) patients were at risk of catastrophic health expenditure. Unplanned reoperation was associated with increased risk of catastrophic health expenditure (p < 0.001), whereas patients with community-based health insurance had decreased risk of catastrophic health expenditure (p < 0.001).

Conclusions
The median hospital charges paid out-of-pocket by patients with health insurance were small in relation to total charges. A significant number of patients with peritonitis are at risk of catastrophic health expenditure.

OSI Number – 10190
PMID – 29143091

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