University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.
Department of Surgery, Kibagabaga Hospital, Kibagabaga, Rwanda.
J Surg Res. 2022 Dec;280:94-102. doi: 10.1016/j.jss.2022.07.011. Epub 2022 Aug 11.
In low-income and middle-income countries, there is a high demand for surgical care, although many individuals lack access due to its affordability, availability, and accessibility. Costs are an important metric in healthcare and can influence healthcare access and outcomes. The aim of this study was to determine the financial impact of infections in acute care surgery patients and factors associated with inability to pay the hospital bill at a Rwandan referral hospital.
This was a prospective observational study of acute care surgery patients at a tertiary referral hospital in Rwanda with infections. Data were collected on demographics, clinical features, hospital charges, and expenses. Factors associated with inability to pay the hospital bill were analyzed using Chi-squared and Wilcoxon rank sum tests.
Over 14 mo, 191 acute care surgery patients with infections were enrolled. Most (n = 174, 91%) patients had health insurance. Median total hospital charges were 414.24 United States Dollars (interquartile range [IQR]: 268.20, 797.48) and median patient charges were 41.53 USD (IQR: 17.15, 103.09). At discharge, 53 (28%) patients were unable to pay their hospital bill. On a univariate analysis actors associated with inability to pay the bill included transportation via ambulance, occupation as a farmer, diagnosis, complications, surgical site infection, and length of hospital stay. On a multivariable analysis, intestinal obstruction (adjusted odds ratio 4.56, 95% confidence interval 1.16, 17.95, P value 0.030) and length of hospital stay more than 7 d (adjusted odds ratio 2.95, 95% confidence interval 1.04, 8.34, P value 0.042) were associated with inability to pay the final hospital bill.
Although there is broad availability of health insurance in Rwanda, hospital charges and other expenses remain a financial burden for many patients seeking surgical care. Further innovative efforts are needed to mitigate expenses and minimize financial risk.
在低收入和中等收入国家，对手术护理的需求很高，但由于其可负担性、可及性和可及性，许多人无法获得手术护理。成本是医疗保健中的一个重要指标，会影响医疗保健的可及性和结果。本研究旨在确定急性外科手术患者感染的经济影响，以及与卢旺达转诊医院无法支付医院账单相关的因素。
这是对卢旺达一家三级转诊医院急性外科手术感染患者的前瞻性观察性研究。收集人口统计学、临床特征、医院收费和费用数据。使用卡方检验和 Wilcoxon 秩和检验分析与无法支付医院账单相关的因素。
在 14 个月期间，共纳入 191 例急性外科手术感染患者。大多数（n=174，91%）患者有健康保险。总住院费用中位数为 414.24 美元（四分位距[IQR]：268.20，797.48），患者费用中位数为 41.53 美元（IQR：17.15，103.09）。出院时，53 名（28%）患者无法支付医院账单。单因素分析表明，无法支付账单的因素包括乘坐救护车、农民职业、诊断、并发症、手术部位感染和住院时间。多因素分析显示，肠梗阻（调整后的优势比 4.56，95%置信区间 1.16，17.95，P 值 0.030）和住院时间超过 7 天（调整后的优势比 2.95，95%置信区间 1.04，8.34，P 值 0.042）与无法支付最终医院账单相关。
尽管卢旺达广泛提供健康保险，但医院收费和其他费用仍给许多寻求手术护理的患者带来经济负担。需要进一步创新努力来减轻费用并降低财务风险。
