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Analysis of financial risk protection indicators in Sri Lanka for pediatric surgery
Assia Comella1, Naveen Wijekoon2, Mailk Samarasinghe2
1Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia.
Insights
Pediatric surgery in Sri Lanka risks impoverishing families, with 25.9% facing catastrophic expenses or poverty. Financial aid is crucial for these vulnerable children and their households.
Area of Science:
- Pediatric Surgery
- Health Economics
- Public Health
Background:
- Surgical care access is critical for pediatric health outcomes.
- Out-of-pocket expenditures for healthcare can lead to financial hardship.
- Understanding the economic impact of pediatric surgery is vital for policy development.
Purpose of the Study:
- To determine the incidence of impoverishment and catastrophic expenditure among Sri Lankan children requiring surgical services.
- To assess the financial burden of pediatric surgical interventions on families in Sri Lanka.
Main Methods:
- Prospective data collection on direct medical and non-medical expenses for pediatric surgical interventions.
- Defined catastrophic expenditure as >10% of household income and impoverishment as falling below the national poverty line.
- Utilized purchasing power parity (PPP) thresholds (I$3.65, I$2.15) and the national poverty line (NPL) for analysis.
Main Results:
- 200 pediatric patients with complete data were analyzed; 96 required emergency surgery.
- The mean total direct expenses per patient were I$116.6, and indirect expenses were I$94.9.
- 53.2% experienced catastrophic expenses, and 85% were below the national poverty line; up to 87.1% faced impoverishment risk.
Conclusions:
- Pediatric surgery in Sri Lanka poses a significant risk of impoverishment and catastrophic expenditure for 25.9% of the population.
- Urgent need for financial assistance and support systems for families undergoing pediatric surgical care.
- Findings highlight the socioeconomic vulnerability associated with accessing essential pediatric surgical services.
Purpose:
To investigate the incidence of the Sri Lankan pediatric population who seek emergency surgical services and who are subsequently at risk of impoverishment and catastrophic expenditure.
Methods:
Prospective data collection at a tertiary pediatric Sri Lankan hospital of direct out-of-pocket (OOP) medical and nonmedical expenses related to pediatric surgical interventions. Catastrophic expenditure and risk of impoverishment were respectively described as expenses superior to 10% of household income and falling below the impoverishment line due to income drop. PPP = purchasing power parity: I$ 3.65, I$ 2.15, and national poverty line (NPL). Distribution of income were estimated using a gamma distribution.
Results:
Two hundred and twenty pediatric patient surveys completed by carers were collected. Two hundred had complete data for analysis. Ninety-six patients required emergency procedures; the others underwent elective surgeries. The overall direct medical and nonmedical expenses (total direct = TD) mean per patient was I$116.6 and the overall indirect expenses mean per patient was I$94.9. 53.2% were affected by catastrophic expense. 85% (n = 170) of the study population was below the NPL. Receiving surgical care would impact up to 74.1% at the NPL threshold and up to 87.1% at the I$3.65 PPP/day limit.
Conclusions:
If pediatric surgery care is required, 25.9% of the Sri Lankan population is at risk of impoverishment or catastrophic expenditure. There is need for financial aid.
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