坦桑尼亚国家医院急诊科就诊受伤患者医疗费用的自付情况：一项前瞻性队列研究。
Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study.
机构信息
Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of.
Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
出版信息
BMJ Open. 2023 Jan 31;13(1):e063297. doi: 10.1136/bmjopen-2022-063297.
OBJECTIVE
We aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs.
DESIGN
Prospective cohort study SETTING: Emergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania.
PARTICIPANTS
Injured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020.
METHODS
During alternating 12-hour shifts, consecutive trauma patients were approached in the ED after stabilisation. A case report form was used to collect social-demographics and patient clinical profile. Total charges billed for ED and in-hospital care and OOP payments were obtained from the hospital billing system. Patients were interviewed by phone to determine the measures they took to pay their bills.
PRIMARY OUTCOME MEASURE
The primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income.
RESULTS
We enrolled 355 trauma patients of whom 51 (14.4%) were insured. The median age was 32 years (IQR 25-40), 238 (83.2%) were male, 162 (56.6%) were married and 87.8% had ≥2 household dependents. The majority 224 (78.3%) had informal employment with a median monthly income of US$86. Overall, 286 (80.6%) had OOP expenses for their care. 95.1% of all patients had an Injury Severity Score <16 among whom OOP payments were US$176.98 (IQR 62.33-311.97). Chest injury and spinal injury incurred the highest OOP payments of US$282.63 (84.71-369.33) and 277.71 (191.02-874.47), respectively. Overall, 85.3% had a CHE. 203 patients (70.9%) were interviewed after discharge. In this group, 13.8% borrowed money from family, and 12.3% sold personal items of value to pay for their hospital bills.
CONCLUSION
OOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania.
目的
本研究旨在确定受伤患者的医疗自付费用（OOP）以及遭遇灾难性医疗支出的患者比例。
设计
前瞻性队列研究
地点
坦桑尼亚达累斯萨拉姆市穆希比利国家医院的急诊科（ED）。
参与者
2019 年 8 月至 2020 年 3 月期间在穆希比利国家医院 ED 就诊的成年受伤患者。
方法
在交替的 12 小时轮班中，在 ED 对稳定后的连续创伤患者进行病例报告表调查。收集社会人口统计学和患者临床特征。从医院计费系统获得 ED 和住院期间护理的总计费和 OOP 支付。通过电话采访患者，以确定他们支付账单的措施。
主要结局测量指标
主要结局是按照世界卫生组织（WHO）的定义，将 OOP 支出≥40%的月收入的患者比例定义为灾难性医疗支出（CHE）。
结果
我们共纳入了 355 名创伤患者，其中 51 名（14.4%）有保险。中位年龄为 32 岁（IQR 25-40），238 名（83.2%）为男性，162 名（56.6%）已婚，87.8%有≥2 个家庭依赖者。大多数患者（78.3%）从事非正规就业，月收入中位数为 86 美元。总体而言，286 名（80.6%）患者为其医疗护理支付了 OOP 费用。95.1%的所有患者的损伤严重程度评分（ISS）<16，其中 OOP 支出为 176.98 美元（IQR 62.33-311.97）。胸部损伤和脊柱损伤的 OOP 支出最高，分别为 282.63 美元（84.71-369.33）和 277.71 美元（191.02-874.47）。总体而言，85.3%的患者发生 CHE。出院后对 203 名患者（70.9%）进行了采访。在这一组中，13.8%的患者向家人借钱，12.3%的患者变卖个人有价值的物品来支付医院账单。
结论
OOP 费用给个人和家庭带来了巨大的经济负担。坦桑尼亚需要采取措施来减少伤害和财务风险。
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