Out-of-pocket payment for surgery in Uganda: The rate of impoverishing and catastrophic expenditure at a government hospital.

BACKGROUND AND OBJECTIVES: It is Ugandan governmental policy that all surgical care delivered at government hospitals in Uganda is to be provided to patients free of charge. In practice, however, frequent stock-outs and broken equipment require patients to pay for large portions of their care out of their own pocket. The purpose of this study was to determine the financial impact on patients who undergo surgery at a government hospital in Uganda. METHODS: Every surgical patient discharged from a surgical ward at a large regional referral hospital in rural southwestern Uganda over a 3-week period in April 2016 was asked to participate. Patients who agreed were surveyed to determine their baseline level of poverty and to assess the financial impact of the hospitalization. Rates of impoverishment and catastrophic expenditure were then calculated. An "impoverishing expense" is defined as one that pushes a household below published poverty thresholds. A "catastrophic expense" was incurred if the patient spent more than 10% of their average annual expenditures. RESULTS: We interviewed 295 out of a possible 320 patients during the study period. 46% (CI 40-52%) of our patients met the World Bank's definition of extreme poverty ($1.90/person/day). After receiving surgical care an additional 10 patients faced extreme poverty, and 5 patients were newly impoverished by the World Bank's definition ($3.10/person/day). 31% of patients faced a catastrophic expenditure of more than 10% of their estimated total yearly expenses. 53% of the households in our study had to borrow money to pay for care, 21% had to sell possessions, and 17% lost a job as a result of the patient's hospitalization. Only 5% of our patients received some form of charity. CONCLUSIONS AND RELEVANCE: Despite the government's policy to provide "free care," undergoing an operation at a government hospital in Uganda can result in a severe economic burden to patients and their families. Alternative financing schemes to provide financial protection are critically needed.

Comportamiento del sangramiento digestivo alto por úlcera péptica: análisis de los costos / Behavior of upper digestive bleeding due to peptic disease: cost analysis

Se realizó un estudio descriptivo prospectivo de 110 pacientes con sangramiento digestivo alto por úlcera péptica, ingresados en el Hospital Universitario "Arnaldo Milián Castro" de Santa Clara, entre octubre de 1998 y marzo de 2000, con el objetivo de determinar aspectos clínico-epidemiológicos de interés en estos enfermos, así como el costo de los exámenes complementarios indicados, de los tratamientos impuestos y el costo total de hospitalización. Los datos fueron obtenidos de las historias clínicas de los pacientes del Departamento de Estadísticas del referido hospital. Se determinó la frecuencia relativa (porcentajes), la media y la desviación estándar en los casos que lo requirieron, así como la prueba de Chi cuadrado. La causa más frecuente de sangramiento digestivo alto fue la úlcera péptica (45,08 por ciento), con mayor afectación en el sexo masculino (65,4 por ciento). Los costos se elevaron en el tratamiento quirúrgico por los exámenes complementarios ($ 5080,42) y se obtuvo un costo total de $ 19240,50, costo realmente bajo al compararlo con muchos de los estudios de autores internacionales; estos datos son muy importantes si relacionamos el costo/beneficio, no sólo del paciente, sino también para la economía del país(AU)