School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
Department of Health Policy and Management, University of Ibadan, Ibadan, Nigeria.
PLoS One. 2020 May 20;15(5):e0232882. doi: 10.1371/journal.pone.0232882. eCollection 2020.
Pre-payment and risk pooling schemes, central to the idea of universal health coverage, should protect households from catastrophic health expenditure and impoverishment; particularly when emergency care is required. Inadequate financial protection consequent on surgical emergencies occurs despite the existence of risk-pooling schemes. This study documented the experiences and coping strategies of slum and non-slum dwellers in a southwestern metropolis of Nigeria who had undergone emergency surgery.
In-depth interviews were conducted with 31 participants (13 slums dwellers, 18 non-slum dwellers) who had recently paid for emergency surgical care in Ibadan. Patients who had experienced catastrophic health expenditure from the use of emergency surgical care were identified and people who paid for the care were purposively selected for the interviews. Using an in-depth interview guide, information on the experiences and overall coping strategies during and after the hospitalization was collected. Data were analyzed inductively using the thematic approach.
The mean age of the 31 participants (consisting of 7 men and 24 women) was 31 ± 5.6years. Apathy to savings limited the preparation for unplanned healthcare needs. Choice of hospital was determined by word of mouth, perceptions of good quality or prompt care and availability of staff. Social networks were relied on widely as a coping mechanism before and during the admission. Patients that were unable to pay experienced poor and humiliating treatment (in severe cases, incarceration). Inability to afford care was exacerbated by double billing and extraneous charges. It was opined that health care should be more affordable for all and that the current National Health Insurance Scheme, that was operating sub-optimally, should be strengthened appropriately for all to benefit.
The study highlights households' poor attitude to health-related savings and pre-payment into a social solidarity fund to cover the costs of emergency surgical care. It also highlights the factors influencing costs of emergency surgical care and the role of social networks in mitigating the high costs of care. Improving financial protection from emergency surgical care would entail promoting a positive attitude to health-related savings, social solidarity and extending the benefits of social health insurance.
预付款和风险池计划是全民健康覆盖理念的核心，应该保护家庭免受灾难性的医疗支出和贫困；特别是在需要紧急护理时。尽管存在风险池计划，但由于手术紧急情况导致的财务保障不足。本研究记录了在尼日利亚西南部大都市的贫民窟和非贫民窟居民在接受紧急手术时的经历和应对策略。
对 31 名参与者（13 名贫民窟居民，18 名非贫民窟居民）进行了深入访谈，他们最近在伊巴丹支付了紧急手术费用。确定了因使用紧急手术而发生灾难性医疗支出的患者，并选择了支付费用的患者进行访谈。使用深入访谈指南，收集了住院期间和住院后的经历和总体应对策略的信息。使用主题方法进行了归纳分析。
31 名参与者（包括 7 名男性和 24 名女性）的平均年龄为 31 ± 5.6 岁。对储蓄的漠不关心限制了对计划外医疗需求的准备。医院的选择取决于口碑、对高质量或及时护理的看法以及员工的可用性。社会网络在入院前后被广泛用作应对机制。无法支付费用的患者经历了糟糕和羞辱性的待遇（在严重情况下，被监禁）。双重计费和额外收费加剧了无法负担医疗费用的问题。有人认为，所有人都应该更容易负担得起医疗保健费用，目前运作不佳的国家健康保险计划应该得到适当加强，以使所有人受益。
该研究强调了家庭对与健康相关的储蓄和预付款进入社会团结基金以支付紧急手术费用的态度不佳。它还强调了影响紧急手术费用的因素以及社会网络在减轻护理高成本方面的作用。改善对紧急手术护理的财务保护需要促进对与健康相关的储蓄、社会团结的积极态度，并扩大社会健康保险的受益范围。
