Analysis of Financial Risk Protection Indicators in Myanmar for Paediatric Surgery
Ramesh Mark Nataraja1,2, Yin Mar Oo3, Lilly Andolfatto4
1Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, 3168, Australia. ram.nataraja@monashhealth.org.
Insights
Many children in Myanmar face impoverishment from emergency surgery costs. Direct non-medical expenses pose the greatest financial risk, highlighting the need for financial protection.
Area of Science:
- Global Health
- Health Economics
- Surgical Outcomes
Background:
- Emergency surgical interventions in low-income countries can lead to significant financial hardship for families.
- Understanding the economic impact of pediatric surgery is crucial for developing effective healthcare policies.
Purpose of the Study:
- To estimate the proportion of Myanmar's pediatric population at risk of impoverishment and catastrophic expenditure due to emergency surgical interventions.
- To analyze the direct medical and non-medical out-of-pocket costs associated with pediatric surgery in Myanmar.
Main Methods:
- Prospective data collection from two tertiary surgical centers in Myanmar.
- Analysis of household income, expenses, and surgery-related costs to determine out-of-pocket (OOP) expenditures.
- Definition of catastrophic expenditure as expenses exceeding 10% of household income and risk of impoverishment based on income thresholds (PPP: US$2.00/day, US$1.25/day, national poverty line).
Main Results:
- 119 surveys provided sufficient data; average OOP costs were US$493 PPP per patient.
- 64% of patients experienced catastrophic expenditure, with up to 44% at risk if surgery is required.
- Direct non-medical costs accounted for 90% of the financial risk; 36.1% were near the national poverty line, with up to 37% at risk of impoverishment.
Conclusions:
- A significant proportion of Myanmar's pediatric population faces impoverishment or catastrophic expenditure following emergency surgery.
- There is an urgent need for financial risk protection mechanisms to mitigate the economic burden of surgical care for children in Myanmar.
Purpose:
To estimate proportion of Myanmar paediatric population at risk of impoverishment and catastrophic expenditure due to emergency surgical intervention.
Methods:
Prospective data were collected at two tertiary surgical centres including income, household expenses, expenses related to surgery. Data analysis was performed to estimate out-of-pocket (OOP) direct medical costs and OOP total costs. Catastrophic expenditure: expense exceeded 10% of household income. Risk of impoverishment: net income drops were below an impoverishment threshold (PPP-purchasing power parity): I$ 2.00 PPP/day, I$ 1.25/day PPP, national poverty line. Distribution of income was estimated using a gamma distribution. Comparison to an adult cohort was performed using Chi-square test with a p value of <0.05 being significant.
Results:
A total of 145 surveys were collected, and 119 (82.1%) contained sufficient data: Paediatric Centre (n = 99) and Adult Centre (n = 20). Overall average per patient direct medical and non-medical OOP costs was I$493: Centre 1: I$540 PPP (range I$41-6,588 PPP) and Centre 2: I$437 PPP (range I$ 36-1,405 PPP). 64% experienced catastrophic expense. There is no significant difference between the centres in the risks of impoverishment or catastrophic expenditure (p = 0.05). Up to 44% are at risk of catastrophic expenditure should surgery be required. Most of the risk (90%) is derived from direct non-medical costs. A high proportion were at the national poverty line threshold (36.1%). Seeking surgical treatment would imperil up to 37% at the national poverty line threshold, and up to 5.7% at the I$2 PPP per day limit.
Conclusions:
A large proportion of the Myanmar population are at risk of impoverishment or catastrophic expenditure should they require surgery. Financial risk protection mechanisms are needed.
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