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Financing Pediatric Surgery: A Provider's Perspective from the Global Initiative for Children's Surgery
Sarah J Ullrich1, Nowrin Tamanna2, Tasmiah Tahera Aziz2
1Department of Surgery, Yale New Haven Hospital, 330 Cedar Street, FMB 107, New Haven, CT, 06510, USA. sarah.ullrich@yale.edu.
Insights
Children undergoing surgery face significant financial hardship, especially in low- and middle-income countries (LMICs). Families in LMICs are 17 times more likely to experience catastrophic health expenditure (CHE) and often must sell assets to afford care.
Area of Science:
- Global Health
- Health Economics
- Pediatric Surgery
Background:
- Catastrophic health expenditure (CHE) affects half the world's population requiring surgery.
- Financial risk protection is a key indicator of healthcare delivery success, prioritized by the Global Initiative for Children's Surgery (GICS).
- Limited data exists on financial risks for pediatric surgical patients.
Purpose of the Study:
- To examine the financial risks for pediatric surgical patients and their families.
- To assess financial protection mechanisms and estimated expenditures from a provider's perspective.
Main Methods:
- Survey of GICS members regarding financial protection and patient expenditures.
- Utilized National Surgical, Obstetric and Anesthesia Planning Surgical Indicators.
- Data analysis included chi-squared, Fisher's exact, and student's t-tests.
Main Results:
- Families in low- and middle-income countries (LMICs) are most likely to decline surgery due to cost.
- Children's surgery in LMICs carries up to 17 times greater odds of catastrophic health expenditure (CHE).
- Over 50% of families in LMICs face CHE after major pediatric surgery; many sell assets to cover costs.
Conclusions:
- Patients in LMICs face greater CHE and less financial protection compared to high-income countries (HICs).
- Interventions are crucial to ensure affordable, safe surgery for children globally.
Background:
Half the world's population is at risk of catastrophic health expenditure (CHE, out-of-pocket spending of more than 10% of annual expenditure) should they require surgery. Protection against CHE is a key indicator of successful health care delivery and has been identified as a priority area by the Global Initiative for Children's Surgery (GICS). Data specific to pediatric surgical patients is limited. This study examines the financial risks for pediatric surgical patients and their families from a provider's perspective.
Methods:
We surveyed GICS members about the existing financial protection mechanisms and estimated expenditures for their patients. Questions were structured based on the National Surgical, Obstetric and Anesthesia Planning Surgical Indicators and finalized based on multi-institutional consensus between high-income country and low-and middle-income country (LMIC) providers. Chi-squared test, Fisher's exact test and student's t-test were used as appropriate.
Results:
Among 107 respondents, 72.4% were from low income or lower-middle income (LIC/LMIC) countries, and 55.1% were attending or consultant physicians. Families were most likely to decline surgery in LIC/LMIC due to inability to afford treatment (mean Likert = 3.77 ± 1.06). The odds of incurring CHE after children's surgery are up to 17 times greater in LIC/LMIC (P = 0.001, unadjusted OR 17.28, 95%CI 2.13-140.02). Over 50% of families of children undergoing major surgery in these settings face CHE. An estimated 5.1% of providers in LIC/LMIC and 56.2% (P < 0.001) of providers in UMIC/HIC reported that families are able to pay for their direct medical costs with the assistance available to them and were more likely to sell assets (74.4% vs. 33.3%, P = 0.005).
Conclusion:
Patients in LMICs are at greater risk for CHE and have less financial risk protection than their HIC counterparts. Given this disparity, intervention is needed to make safe surgery affordable for children worldwide.
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