Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
Duke Global Health Institute, Duke University, Durham, North Carolina, USA.
BMJ Open. 2023 May 2;13(5):e069572. doi: 10.1136/bmjopen-2022-069572.
An estimated 1.7 billion children around the world do not have access to safe, affordable and timely surgical care, with the financing through out-of-pocket (OOP) expenses being one of the main barriers to care. Our study modelled the impact of reducing OOP costs related to surgical care for children in Somaliland on the risk of catastrophic expenditures and impoverishment.
This cross-sectional nationwide economic evaluation modelled several different approaches to reduction of paediatric OOP surgical costs in Somaliland.
A surgical record review of all procedures on children up to 15 years old was conducted at 15 surgically capable hospitals. We modelled two rates of OOP cost reduction (reduction of OOP proportion from 70% to 50% and from 70% to 30% reduction in OOP costs) across five wealth quintiles (poorest, poor, neutral, rich, richest) and two geographical areas (urban and rural). The outcome measures of the study are catastrophic expenditures and risk of impoverishment due to surgery. We followed the Consolidated Health Economic Evaluation Reporting Standards.
We found that the risk of catastrophic and impoverishing expenditures related to OOP expenditures for paediatric surgery is high across Somaliland, but most notable in the rural areas and among the poorest quintiles. Reducing OOP expenses for surgical care to 30% would protect families in the richest wealth quintiles while minimally affecting the risk of catastrophic expenditure and impoverishment for those in the lowest wealth quintiles, particularly those in rural areas.
Our models suggest that the poorest communities in Somaliland lack protection against the risk of catastrophic health expenditure and impoverishment, even if OOP payments are reduced to 30% of surgical costs. A comprehensive financial protection in addition to reduction of OOP costs is required to prevent risk of impoverishment in these communities.
全球约有 17 亿儿童无法获得安全、负担得起和及时的外科护理，其中通过自费（OOP）支付费用是获得护理的主要障碍之一。我们的研究通过对索马里兰儿童外科护理 OOP 成本降低对灾难性支出和贫困风险的影响进行建模。
本横断面全国经济评估对索马里兰降低儿科 OOP 手术成本的几种不同方法进行了建模。
对 15 家有手术能力的医院 15 岁以下儿童的所有手术记录进行了回顾。我们在五个财富五分位数（最贫穷、贫穷、中性、富有、最富有）和两个地理区域（城市和农村）中模拟了两种 OOP 成本降低率（OOP 比例从 70%降低到 50%和 OOP 成本降低 70%）。该研究的结果衡量指标是由于手术而导致的灾难性支出和贫困风险。我们遵循了《综合健康经济评估报告标准》。
我们发现，索马里兰的儿科手术 OOP 支出存在较高的灾难性和贫困性支出风险，但在农村地区和最贫穷的五分位数中最为明显。将外科护理的 OOP 费用降低到 30%将保护最富有五分位数的家庭，而对最低五分位数（特别是农村地区）的灾难性支出和贫困风险的影响最小。
我们的模型表明，索马里兰最贫穷的社区缺乏对灾难性健康支出和贫困风险的保护，即使 OOP 支付降低到手术费用的 30%。除了降低 OOP 成本外，还需要全面的财务保护，以防止这些社区陷入贫困。
