Department of Surgery, Yale New Haven Hospital, 330 Cedar Street, FMB 107, New Haven, CT, 06510, USA.
Department of Pediatric Surgery, Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh.
World J Surg. 2022 May;46(5):1220-1234. doi: 10.1007/s00268-022-06463-7. Epub 2022 Feb 17.
Half the world's population is at risk of catastrophic health expenditure (CHE, out-of-pocket spending of more than 10% of annual expenditure) should they require surgery. Protection against CHE is a key indicator of successful health care delivery and has been identified as a priority area by the Global Initiative for Children's Surgery (GICS). Data specific to pediatric surgical patients is limited. This study examines the financial risks for pediatric surgical patients and their families from a provider's perspective.
We surveyed GICS members about the existing financial protection mechanisms and estimated expenditures for their patients. Questions were structured based on the National Surgical, Obstetric and Anesthesia Planning Surgical Indicators and finalized based on multi-institutional consensus between high-income country and low-and middle-income country (LMIC) providers. Chi-squared test, Fisher's exact test and student's t-test were used as appropriate.
Among 107 respondents, 72.4% were from low income or lower-middle income (LIC/LMIC) countries, and 55.1% were attending or consultant physicians. Families were most likely to decline surgery in LIC/LMIC due to inability to afford treatment (mean Likert = 3.77 ± 1.06). The odds of incurring CHE after children's surgery are up to 17 times greater in LIC/LMIC (P = 0.001, unadjusted OR 17.28, 95%CI 2.13-140.02). Over 50% of families of children undergoing major surgery in these settings face CHE. An estimated 5.1% of providers in LIC/LMIC and 56.2% (P < 0.001) of providers in UMIC/HIC reported that families are able to pay for their direct medical costs with the assistance available to them and were more likely to sell assets (74.4% vs. 33.3%, P = 0.005).
Patients in LMICs are at greater risk for CHE and have less financial risk protection than their HIC counterparts. Given this disparity, intervention is needed to make safe surgery affordable for children worldwide.
全球一半人口面临灾难性医疗支出（CHE，即自付支出超过年度支出的 10%）的风险，如果他们需要手术。防范 CHE 是成功提供医疗保健的关键指标，全球儿童外科倡议（GICS）已将其确定为优先领域。儿科外科患者的具体数据有限。本研究从提供者的角度检查了儿科外科患者及其家庭的财务风险。
我们向 GICS 成员调查了现有的财务保护机制，并估算了患者的支出。问题是根据国家外科、产科和麻醉规划外科指标构建的，并根据高收入国家和中低收入国家（LMIC）提供者之间的机构间共识进行了最终确定。使用卡方检验、Fisher 确切检验和学生 t 检验。
在 107 名受访者中，72.4%来自低收入或中下收入国家（LIC/LMIC），55.1%是主治医生或顾问医生。由于无力负担治疗费用，家庭最有可能在 LIC/LMIC 地区拒绝手术（平均 Likert 评分=3.77±1.06）。在 LIC/LMIC，儿童手术后发生 CHE 的可能性高达 17 倍（P=0.001，未调整的比值比 17.28，95%CI 2.13-140.02）。在这些环境中接受重大手术的儿童的 50%以上家庭面临 CHE。估计 5.1%的 LIC/LMIC 提供者和 56.2%（P<0.001）的中高收入国家/地区（UMIC/HIC）提供者报告说，在他们提供的援助下，家庭能够支付直接医疗费用，并且更有可能出售资产（74.4%比 33.3%，P=0.005）。
与高收入国家相比，中低收入国家的患者面临更大的 CHE 风险，并且财务风险保护较少。鉴于这种差异，需要采取干预措施，使全球儿童都能负担得起安全手术的费用。
