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Oladeji EO, Ezeme C, Baiyewu LA, Okunola MO, Ogunlade SO. The catastrophic cost of motorcycle road traffic injuries: Experience from a major reference centre in a lower-middle income country. Injury 2024; 55:111314. [PMID: 38233327 DOI: 10.1016/j.injury.2024.111314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Motorcycle crashes are an increasing public health problem in low- and middle-income countries (LMICs). An accurate estimation of the economic burden of these crashes could be complex owing to a prevalent system of out-of-pocket (OOP) payment for health care services in these countries. Our study aims to objectively evaluate the cost implication of motorcycle Road Traffic Injuries (RTIs) among road crash victims managed at a major trauma reference hospital in Nigeria. Two economic evaluation methods were used to accurately reflect the cost-of-care (C-o-C) of each victim as well as for cross-validation. METHOD This is a prospective cohort study conducted between August 2020 and May 2021. All patients involved in motorcycle road traffic crashes presenting to the Emergency Department of the University College Hospital, Ibadan, Nigeria, were included in the study. For each patient, all medical expenses from the time of injury (T0) to 30 days after injury (T30) or Time to death (TD) - whichever occurred first, were valued in costs, and added (Activity-based costing or ABC), while also estimating overall cost-of-care (C-o-C) at T30 or TD, using the willingness-to-pay (WTP) method. Following the WHO definition, catastrophic expenditure was defined as expenditure > 25% of the patient's estimated annual household income. RESULTS Of the 150 consecutively managed motorcycle crashes victims during the study period, 112 had complete data. The median monthly household income for the cohort was $121 with 75% of them earning less than $180. The median cost-of-care (C-o-C), by ABC, was $242 ($143 - 828). For individual care items, expenditure on surgical intervention(s) was the highest followed by prosthesis and implant procurement, and radiological investigations. On the other hand, the estimated medical cost was $2356 (IQR $938 - 6475) by WTP. Only 14% had health insurance coverage. The overall expenditure was catastrophic for 46% of the patients. Monthly household income of < $180 (AOR=9.2; 95% CI=2.6-32.8; p < 0.001), absence of health insurance coverage (AOR=10.7; 95% CI=1.1-101.6; p = 0.040), and prolonged hospital stay above 14 days (AOR=25.1; 95% CI=5.5 -115.1; p = 0.001) were predictors of catastrophic expenditure. There was a weak positive correlation between actual cost-of-care using the ABC method and WTP (r = 0.247; p = 0.102). CONCLUSION The aggregate cost of motorcycle RTIs is catastrophic for nearly half of the victims attending the University College Hospital, Ibadan. The willingness-to-pay method, though less tedious is often less reliable in these settings owing to a prevalent OOP payment system. This study identified the need to implement effective financial protection mechanisms against the high OOP expenditure faced by motorcycle crash victims in LMICs.
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Affiliation(s)
- E O Oladeji
- Department of Surgery, University College Hospital Ibadan, Nigeria; Department of Trauma and Orthopaedics, St. Richard's Hospital Chichester, UK
| | - C Ezeme
- Department of Surgery, University College Hospital Ibadan, Nigeria; Department of Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, South Yorkshire, England, UK.
| | - L A Baiyewu
- Department of Surgery, University College Hospital Ibadan, Nigeria; Division of Cardiothoracic Surgery, Department of Surgery, University College Hospital Ibadan, Nigeria; Department of Surgery, College of Medicine, University of Ibadan, Nigeria
| | - M O Okunola
- Department of Orthopaedics and Trauma, University College Hospital Ibadan, Nigeria
| | - S O Ogunlade
- Department of Orthopaedics and Trauma, University College Hospital Ibadan, Nigeria; Department of Surgery, College of Medicine, University of Ibadan, Nigeria
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Kibu OD, Kepgang E, Sinsai R, Conner A, Asahngwa C, Ngwa W, Ngo NV, Fobellah NN, Muenyi CS, Zalamea NN, Gobina RM, Foretia DA. Barriers and Motivations for Health Insurance Subscription Among Health-Care Users in Cameroon. J Surg Res 2024; 293:158-167. [PMID: 37774593 DOI: 10.1016/j.jss.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/12/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Surgical care is a significant component of the overall health expenditure in low- and middle-income countries. In Cameroon, out-of-pocket payments for surgical service are very high with many patients declining potentially curative surgical procedures. Less than 2% of the population is enrolled in a health insurance scheme leading to a propensity for catastrophic health expenses when accessing care. To assess the perceived barriers and motivations for health insurance subscription among health-care users in Cameroon. METHODS This was a cross-sectional community-based qualitative study conducted in the Center Region of Cameroon. A total of 37 health-care users (health insurance subscribers and nonsubscribers) were purposively identified. Four focused group discussions and thirteen in-depth interviews were conducted. All anonymized transcripts were analyzed using a thematic analysis approach. RESULTS The six major themes identified as barriers to health insurance subscription were lack of trust in the existing health insurance schemes, inadequate knowledge on how health insurance works, premiums believed to be too expensive, the complexity of the claims processing system, minimal usage of health-care services and practice of self-medication. Motivational factors included the knowledge of having access to quality health services even without money in the event of an unforeseen illness and having a large family/household size. The importance of mass sensitization on the benefits of health insurance was noted. CONCLUSION Health insurance is still very underutilized in Cameroon. This results in significant out-of-pocket payment for health services by Cameroonians with catastrophic consequences to households. With most Cameroonians in the informal sector and underemployed, it is imperative to put in place a national strategic plan to overcome existing barriers and increase health insurance coverage especially among the poor. This has the potential to significantly increase access to safe, quality, timely and affordable surgical care.
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Affiliation(s)
- Odette D Kibu
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Public Health and Hygiene, University of Buea, Buea, Cameroon
| | - Evrard Kepgang
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | - Regina Sinsai
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | - Anna Conner
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Constantine Asahngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Anthropology, University of Yaoundé 1, Yaounde, Cameroon
| | - Wilfred Ngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | - Ngo V Ngo
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | - Nkengafac N Fobellah
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | | | - Nia N Zalamea
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ronald M Gobina
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Surgery, Buea Regional Hospital, Southwest Region, Cameroon
| | - Denis A Foretia
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, Tennessee.
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Yang P, Yang R, Luo Y, Zhang Y, Hu M. Hospitalization costs of road traffic injuries in Hunan, China: A quantile regression analysis. ACCIDENT; ANALYSIS AND PREVENTION 2024; 194:107368. [PMID: 37907040 DOI: 10.1016/j.aap.2023.107368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Healthcare expenditure of road traffic injuries in China has not been adequately investigated so far. We aim to provide comprehensive information about the hospitalization costs of inpatients who suffered road traffic injuries, and explore the components and influencing factors of costs. METHODS We extracted the data of all inpatients (n = 60535) with road traffic injuries during the year 2019 from Chinese National Health Statistics Network Reporting System database in Hunan, China. We calculated the components of hospitalization costs and analyzed the association between hospitalization costs and patient characteristics using quantile regression models. RESULTS The median hospitalization cost was $853.48, and the median length of hospital stay was 9 days. Vulnerable road users accounted for 84.9 % of all cases. Medicine cost is the first driver of hospitalization cost, accounting for 25.94 %. In the low- and medium-cost groups, hospitalization costs were highly concentrated on diagnosis, medicine, and medical services, while in the high-cost groups, consumable cost constituted the highest percentage. Male, a longer length of stay, more severe injuries, two or more comorbidities, surgical treatment, and admission to tertiary hospitals were significantly associated with higher hospitalization costs, and the regression coefficients increased with increasing of quartile points. Costs were lower in the 0-14 years group than in the other groups across all quartiles. At the median, occupants of heavy transport vehicle incurred the highest costs, $44.18 higher than pedestrians; injuries at lower extremities generated higher costs than those at any other site; and vascular injuries caused the greatest costs, $786.24 higher than superficial injuries. CONCLUSIONS Road traffic injuries cause huge healthcare costs for victims, most of whom are vulnerable road users. The total cost of hospitalization is incurred mainly for medicine, consumables, diagnosis, medical services, and treatment. Patients' demographic factors (gender and age), clinical factors (injury severity, location, nature, and number of comorbidities), treatment factors (surgery, length of stay, and hospital level), and road user type are all significantly associated with hospitalization costs.
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Affiliation(s)
- Panzi Yang
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan Province 410078, China
| | - Rusi Yang
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan Province 410078, China
| | - Yangzhenlin Luo
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan Province 410078, China
| | - Yixin Zhang
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan Province 410078, China
| | - Ming Hu
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan Province 410078, China.
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Gulamhussein MA, Sawe HR, Kilindimo S, Mfinanga JA, Mussa R, Hyuha GM, Rwegoshora S, Shayo F, Mdundo W, Sadiq AM, Weber EJ. Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study. BMJ Open 2023; 13:e063297. [PMID: 36720574 PMCID: PMC9890776 DOI: 10.1136/bmjopen-2022-063297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE We aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs. DESIGN Prospective cohort study SETTING: Emergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania. PARTICIPANTS Injured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020. METHODS During alternating 12-hour shifts, consecutive trauma patients were approached in the ED after stabilisation. A case report form was used to collect social-demographics and patient clinical profile. Total charges billed for ED and in-hospital care and OOP payments were obtained from the hospital billing system. Patients were interviewed by phone to determine the measures they took to pay their bills. PRIMARY OUTCOME MEASURE The primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income. RESULTS We enrolled 355 trauma patients of whom 51 (14.4%) were insured. The median age was 32 years (IQR 25-40), 238 (83.2%) were male, 162 (56.6%) were married and 87.8% had ≥2 household dependents. The majority 224 (78.3%) had informal employment with a median monthly income of US$86. Overall, 286 (80.6%) had OOP expenses for their care. 95.1% of all patients had an Injury Severity Score <16 among whom OOP payments were US$176.98 (IQR 62.33-311.97). Chest injury and spinal injury incurred the highest OOP payments of US$282.63 (84.71-369.33) and 277.71 (191.02-874.47), respectively. Overall, 85.3% had a CHE. 203 patients (70.9%) were interviewed after discharge. In this group, 13.8% borrowed money from family, and 12.3% sold personal items of value to pay for their hospital bills. CONCLUSION OOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania.
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Affiliation(s)
- Masuma A Gulamhussein
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Hendry Robert Sawe
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Said Kilindimo
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Juma A Mfinanga
- Emergency Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania, United Republic of
| | - Raya Mussa
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Gimbo M Hyuha
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Shamila Rwegoshora
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Frida Shayo
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Winnie Mdundo
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Abid M Sadiq
- Emergency Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania, United Republic of
| | - Ellen J Weber
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
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Eze P, Lawani LO, Agu UJ, Amara LU, Okorie CA, Acharya Y. Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review. PLoS One 2022; 17:e0276266. [PMID: 36264930 PMCID: PMC9584403 DOI: 10.1371/journal.pone.0276266] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE A non-negligible proportion of sub-Saharan African (SSA) households experience catastrophic costs accessing healthcare. This study aimed to systematically review the existing evidence to identify factors associated with catastrophic health expenditure (CHE) incidence in the region. METHODS We searched PubMed, CINAHL, Scopus, CNKI, Africa Journal Online, SciELO, PsycINFO, and Web of Science, and supplemented these with search of grey literature, pre-publication server deposits, Google Scholar®, and citation tracking of included studies. We assessed methodological quality of included studies using the Appraisal tool for Cross-Sectional Studies for quantitative studies and the Critical Appraisal Skills Programme checklist for qualitative studies; and synthesized study findings according to the guidelines of the Economic and Social Research Council. RESULTS We identified 82 quantitative, 3 qualitative, and 4 mixed-methods studies involving 3,112,322 individuals in 650,297 households in 29 SSA countries. Overall, we identified 29 population-level and 38 disease-specific factors associated with CHE incidence in the region. Significant population-level CHE-associated factors were rural residence, poor socioeconomic status, absent health insurance, large household size, unemployed household head, advanced age (elderly), hospitalization, chronic illness, utilization of specialist healthcare, and utilization of private healthcare providers. Significant distinct disease-specific factors were disability in a household member for NCDs; severe malaria, blood transfusion, neonatal intensive care, and distant facilities for maternal and child health services; emergency surgery for surgery/trauma patients; and low CD4-count, HIV and TB co-infection, and extra-pulmonary TB for HIV/TB patients. CONCLUSIONS Multiple household and health system level factors need to be addressed to improve financial risk protection and healthcare access and utilization in SSA. PROTOCOL REGISTRATION PROSPERO CRD42021274830.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, United States of America
| | - Lucky Osaheni Lawani
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Ujunwa Justina Agu
- Department of Community Medicine, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Linda Uzo Amara
- Department of Community Medicine, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Cassandra Anurika Okorie
- Department of Community Medicine, Ebonyi State University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Yubraj Acharya
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, United States of America
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