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Catastrophic expenditure to pay for surgery worldwide: a modelling study
Mark G Shrime1, Anna J Dare2, Blake C Alkire3
1Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Surgery costs drive 81 million people into financial catastrophe annually. Half the global population risks this expenditure, disproportionately affecting low-income nations and the poor, underscoring the need for financial risk protection.
Area of Science:
- Global Health Economics
- Surgical Outcomes
- Financial Risk Protection
Background:
- Medical costs alone cause catastrophic expenditure for ~150 million globally each year.
- Non-medical costs associated with accessing care further increase this financial burden.
- The impact of surgical conditions on financial catastrophe is unknown but critical for global poverty reduction goals.
Purpose of the Study:
- To quantify the global incidence of catastrophic expenditure associated with surgical conditions.
- To inform the development of financial risk protection mechanisms for surgical care.
Main Methods:
- A stochastic model was developed to estimate global catastrophic expenditure due to surgery.
- The model incorporated country-specific income distributions, surgical probability, and associated medical/non-medical costs.
- Sensitivity analyses were performed to assess model robustness.
Main Results:
- 3.7 billion people risk catastrophic expenditure if needing surgery.
- Annually, 81.3 million people face financial catastrophe from surgery costs (32.8M medical, 48.5M non-medical).
- Catastrophic expenditure burden is highest in low- and middle-income countries, disproportionately affecting the poor.
Conclusions:
- Half the global population is at risk of financial catastrophe from surgery.
- Surgical conditions cause 81 million annual cases of catastrophic expenditure, with non-medical costs comprising over half.
- Financial risk protection for surgery is essential in health-system design.
