Kessy Joackim P, Lewallen Susan
Kilimanjaro Centre for Community Ophthalmology, Tumaini University/KCMC Hospital, Moshi, Tanzania.
Br J Ophthalmol. 2007 Sep;91(9):1114-6. doi: 10.1136/bjo.2006.112474.
Many sub-Saharan African governments expect patients to contribute towards health care. We investigated what happens to patients who reported being too poor too pay for cataract surgery.
Over 1 year, patients who did not accept cataract surgery after being advised to do so at outreach clinics were enrolled in a prospective cohort study, then followed-up to determine who returned. A subsample was traced for further interviews to learn what they had undertaken to try to obtain funds.
A total of 198 patients did not accept surgery and 157 (79%) of these stated the reason was lack of funds. At follow-up, 36 had returned for surgery, 32 with money and 4 with letters from village leaders verifying inability to pay. There was no association between age, sex, or blindness and returning. Interviews with a representative subsample revealed that 44% patients with stated poverty actually had other reasons for not accepting surgery; only 22% took advantage of a free waiver issued at the interview.
Of patients who reported being too poor to pay for cataract surgery, 20% accessed funds after counselling. A significant proportion of those who did not return supplied other reasons for not accepting surgery when interviewed later at home, and did not use a free waiver granted at that time. Access to health care is a complex issue; however, this study does not support the notion that charging small fees for cataract surgery in this setting creates a major barrier to access. That said, it is important to find simple, valid methods to identify those too poor to pay for surgery if we hope to develop sustainable systems to achieve VISION 2020 targets.
许多撒哈拉以南非洲国家的政府期望患者为医疗保健付费。我们调查了那些报告因太穷而无力支付白内障手术费用的患者的情况。
在1年多的时间里，在外展诊所被建议进行白内障手术后却未接受手术的患者被纳入一项前瞻性队列研究，随后进行随访以确定谁回来了。对一个子样本进行追踪以便进一步访谈，了解他们为获取资金所采取的措施。
共有198名患者未接受手术，其中157名（79%）表示原因是资金短缺。随访时，36人回来接受了手术，32人带着钱，4人带着村长写的证明无力支付的信件。年龄、性别或失明状况与回来接受手术之间没有关联。对一个具有代表性的子样本进行访谈发现，声称贫困的患者中44%实际上有其他不接受手术的原因；只有22%利用了访谈时发放的免费豁免。
在那些报告因太穷而无力支付白内障手术费用的患者中，20%在接受咨询后获得了资金。相当一部分未回来的患者在后来在家中接受访谈时给出了不接受手术的其他原因，并且没有使用当时给予的免费豁免。获得医疗保健是一个复杂的问题；然而，本研究并不支持在这种情况下对白内障手术收取小额费用会造成获取医疗服务的重大障碍这一观点。话虽如此，如果我们希望建立可持续的系统以实现“视觉2020”目标，找到简单、有效的方法来识别那些太穷而无力支付手术费用的人是很重要的。
