Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
PLoS One. 2021 Oct 15;16(10):e0258532. doi: 10.1371/journal.pone.0258532. eCollection 2021.
Utilizing surgical services, including caesarean sections, can result in catastrophic expenditure and impoverishment. In 2010, Sierra Leone introduced the Free Health Care Initiative (FHCI), a national financial risk protection program for the most vulnerable groups. Aim of this study was to investigate catastrophic expenditure and impoverishment related to caesarean section in Sierra Leone and evaluate the impact of the FHCI.
Women who delivered by caesarean section in nine hospitals were followed up with home visits one month after surgery, and data on medical and non-medical expenditures were collected. Individual income was estimated based on household characteristics and used to determine catastrophic expenditure and impoverishment for each patient. The impact of the FHCI was assessed by comparing actual expenditure with counterfactual expenditures had the initiative not existed.
For the 1146 patients in the study, the median expenditure was 23 (IQR 4; 56) international dollars (Int$). Patients in the poorest quintile spent a median Int$ 59 (IQR 28; 76), which was significantly more than patients in the richest quintile, who spent a median Int$ 17 (IQR 2; 38, p<0.001). Travel (32.9%) and food (28.7%) were the two largest expenses. Catastrophic expenditure was encountered by 12.0% and 4.0% (10% and 25% threshold, respectively) of the women. Without the FHCI, 66.1% and 28.8% of the women would have encountered catastrophic expenditure.
Many women in Sierra Leone face catastrophic expenditure related to caesarean section, mainly through food and travel expenses, and the poor are disproportionally affected. The FHCI is effective in reducing the risk of catastrophic expenditure related to caesarean section, but many patients are still exposed to financial hardship, suggesting that additional support is needed for Sierra Leone's poorest patients.
利用外科服务，包括剖宫产，可能导致灾难性支出和贫困。2010 年，塞拉利昂推出了免费医疗保健倡议（FHCI），这是一个针对最弱势群体的国家财务风险保护计划。本研究旨在调查塞拉利昂剖宫产相关的灾难性支出和贫困情况，并评估 FHCI 的影响。
在九家医院接受剖宫产的妇女在手术后一个月进行家访，并收集医疗和非医疗支出数据。根据家庭特征估算个人收入，并用于确定每位患者的灾难性支出和贫困程度。通过比较不存在该倡议时的实际支出和假设支出来评估 FHCI 的影响。
在这项研究的 1146 名患者中，中位数支出为 23（IQR 4；56）国际美元（Int$）。最贫困五分位数的患者支出中位数为 59（IQR 28；76），明显高于最富裕五分位数的患者，支出中位数为 17（IQR 2；38，p<0.001）。旅行（32.9%）和食物（28.7%）是两个最大的支出。12.0%和 4.0%（分别为 10%和 25%的阈值）的女性遭遇了灾难性支出。如果没有 FHCI，66.1%和 28.8%的女性将面临灾难性支出。
塞拉利昂的许多妇女因剖宫产而面临灾难性支出，主要通过食物和旅行支出，贫困人口受到的影响不成比例。FHCI 可有效降低剖宫产相关灾难性支出的风险，但许多患者仍面临经济困难，表明塞拉利昂最贫困的患者需要额外的支持。
