College of Health Sciences, Addis Ababa University, Zambia Street, P.O.Box 8977, Addis Ababa, Ethiopia.
St Paul's Millennium Medical College, Addis Ababa, Ethiopia.
BMC Health Serv Res. 2022 Aug 26;22(1):1090. doi: 10.1186/s12913-022-08480-7.
The Lancet Commission on Global Surgery suggested six indicators every country should use to measure their surgical systems. One of these indicators, catastrophic expenditure (CE), is defined as money paid for service which amounts to more than 10% of the patient's total annual expenditure, or more than 40% of annual non-food household expenditure. Ethiopian Ministry of Health has set a target of 100% protection from CE by 2030. However, so far there is lack of studies that assess financial risk of surgery.
Using a cross sectional study design, financial risk assessment was carried out on 142 patients from Yekatit 12 and Zewditu Memorial hospitals in Addis Ababa, Ethiopia from May 15 to September 15, 2021.
Appendectomy (69.0%), emergency laparotomy (26.1%) and cholecystectomy (4.9%) resulted in mean direct medical expenditures of 111.7USD, 200.70USD and 224.60USD, respectively. Medications and imaging accounted for 60.8 and 13.9% of total treatment cost. By applying the two definitions of catastrophic expenditure, 67.6 and 62.7% of patients sustained CE, respectively Overall rates of CE across procedures were 67.3 and 59.1% for appendectomy, 70.2 and 70.2% for laparotomy, 57.0 and 71.2% for cholecystectomy. Thirty-five (24.6%) patients had some form of insurance, with Community Based Health Insurance being the most common form (57%). Insured patients were less likely to sustain CE with both definitions (AOR 0.09, p = 0.002 and AOR 0.10, p = 0.006 respectively).
Substantial proportion of patients undergoing emergency abdominal surgery sustain CE in Addis Ababa. Medications and imaging take major share of total cost mainly because patients have to acquire them from private set ups. Policy makers should work on availing medications and imaging in public hospitals as well as expand insurance and other forms of surgical care financing to protect patients from CE.
柳叶刀全球外科学委员会建议每个国家都应使用六项指标来衡量其外科学系统。这些指标之一是灾难性支出（CE），定义为用于服务的支出超过患者总年度支出的 10%，或超过年度非食品家庭支出的 40%。埃塞俄比亚卫生部已设定目标，即在 2030 年实现 100%的 CE 保护。然而，到目前为止，还缺乏评估手术财务风险的研究。
采用横断面研究设计，于 2021 年 5 月 15 日至 9 月 15 日，对来自亚的斯亚贝巴 Yekatit 12 医院和 Zewditu 纪念医院的 142 名患者进行了财务风险评估。
阑尾切除术（69.0%）、急诊剖腹术（26.1%）和胆囊切除术（4.9%）的直接医疗费用分别为 111.7 美元、200.70 美元和 224.60 美元。药物和影像学检查占总治疗费用的 60.8%和 13.9%。根据灾难性支出的两种定义，分别有 67.6%和 62.7%的患者发生 CE。阑尾切除术、剖腹术、胆囊切除术的总体 CE 发生率分别为 67.3%和 59.1%、70.2%和 70.2%、57.0%和 71.2%。35 名（24.6%）患者有某种形式的保险，其中社区医疗保险是最常见的形式（57%）。根据两种定义，有保险的患者发生 CE 的可能性较小（OR 0.09，p=0.002 和 OR 0.10，p=0.006）。
在亚的斯亚贝巴，接受急诊腹部手术的患者中有相当大比例的人发生 CE。药物和影像学检查占总费用的主要部分，主要是因为患者必须从私立机构获得这些药物和影像学检查。政策制定者应努力在公立医院提供药物和影像学检查，并扩大保险和其他形式的手术护理融资，以保护患者免受 CE 的影响。
