在尼日利亚北部赞法拉州接受白内障手术的患者中，直接非医疗费用使患者的总直接费用增加了一倍：病例系列研究
Direct non-medical costs double the total direct costs to patients undergoing cataract surgery in Zamfara state, Northern Nigeria: a case series.
作者信息
Ibrahim Nazaradden, Pozo-Martin Francisco, Gilbert Clare
机构信息
Zamfara State Eye Care Programme, Ministry of Health, Gusau, Nigeria.
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
出版信息
BMC Health Serv Res. 2015 Apr 16;15:163. doi: 10.1186/s12913-015-0831-2.
BACKGROUND
Cost is frequently reported as a barrier to cataract surgery, but few studies have reported costs of accessing surgery in Africa. The purpose of this prospective, facility based study was to compare direct non-medical cost with total direct cost of cataract surgery to patients, and to assess how money was found to cover costs.
METHODS
Participants were those aged 17 years and above attending their first post-operative visit after first eye, subsidised, day case cataract surgery. Systematic random sampling was used to select participants who were interviewed to obtain data on socio-demographic details, and on expenditure during the assessment visit, the surgical visit, and the first follow-up visit. Costs were a) direct medical costs (patients' costs for registration, investigations, surgery, medication), and b) direct non-medical costs (patients' and escorts' costs for transport, accommodation, meals). The source of funds to pay for the services received was also assessed.
RESULTS
Almost two thirds (63%) of the 104 participants were men. The mean age of men was 64 (± 12.5) years, being 63 (± 12.9) years for women. All men were married and 35% of women were widows. 84% of men were household heads compared with 6% of women. The median total direct cost for all visits by all participants was N8,245 (US$51), being higher for men than women (N9,020; US$56 and N7,620; US$47) (p < 0.09) respectively. Direct non-medical cost constituted 49% of total direct cost. 92% of participants had adequate money to pay, but 8% had to sell possessions to raise the money. 20% of unmarried women sold possessions or took out a loan.
CONCLUSION
Despite the subsidy, cost is still likely to be a barrier to accessing cataract surgery, as the total direct costs represented at least 50 days income for 70% of the local population. Provision of transport would reduce direct non-medical costs.
背景
成本经常被报道为白内障手术的一个障碍，但很少有研究报道非洲进行白内障手术的费用情况。这项基于医疗机构的前瞻性研究的目的是比较白内障手术患者的直接非医疗成本与总直接成本，并评估支付费用的资金来源。
方法
参与者为年龄在17岁及以上、接受首次单眼补贴日间白内障手术后首次术后随访的患者。采用系统随机抽样法选择参与者，对其进行访谈以获取社会人口学详细信息以及评估访视、手术访视和首次随访期间的支出数据。成本包括：a）直接医疗成本（患者的挂号、检查、手术、药物费用），以及b）直接非医疗成本（患者及其陪护人员的交通、住宿、餐饮费用）。还评估了支付所接受服务费用的资金来源。
结果
104名参与者中近三分之二（63%）为男性。男性的平均年龄为64（±12.5）岁，女性为63（±12.9）岁。所有男性均已婚，35%的女性为寡妇。84%的男性为户主，而女性仅占6%。所有参与者所有访视的总直接成本中位数为8245奈拉（51美元），男性高于女性（分别为9020奈拉；56美元和7620奈拉；47美元）（p < 0.09）。直接非医疗成本占总直接成本的49%。92%的参与者有足够的钱支付，但8%的人不得不出售财产来筹集资金。20%的未婚女性出售财产或贷款。
结论
尽管有补贴，但成本仍可能是获得白内障手术的一个障碍，因为总直接成本至少相当于当地70%人口50天的收入。提供交通服务将降低直接非医疗成本。
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