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. 2023 Jan 31;13(1):e063297.
doi: 10.1136/bmjopen-2022-063297.

Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study

Masuma A Gulamhussein  1 , Hendry Robert Sawe  2 , Said Kilindimo  1 , Juma A Mfinanga  3 , Raya Mussa  1 , Gimbo M Hyuha  1 , Shamila Rwegoshora  1 , Frida Shayo  1 , Winnie Mdundo  1 , Abid M Sadiq  4 , Ellen J Weber  5
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Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study

Masuma A Gulamhussein et al. BMJ Open. .

Abstract

Objective: We aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs.

Design: Prospective cohort study SETTING: Emergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania.

Participants: Injured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020.

Methods: During alternating 12-hour shifts, consecutive trauma patients were approached in the ED after stabilisation. A case report form was used to collect social-demographics and patient clinical profile. Total charges billed for ED and in-hospital care and OOP payments were obtained from the hospital billing system. Patients were interviewed by phone to determine the measures they took to pay their bills.

Primary outcome measure: The primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income.

Results: We enrolled 355 trauma patients of whom 51 (14.4%) were insured. The median age was 32 years (IQR 25-40), 238 (83.2%) were male, 162 (56.6%) were married and 87.8% had ≥2 household dependents. The majority 224 (78.3%) had informal employment with a median monthly income of US$86. Overall, 286 (80.6%) had OOP expenses for their care. 95.1% of all patients had an Injury Severity Score <16 among whom OOP payments were US$176.98 (IQR 62.33-311.97). Chest injury and spinal injury incurred the highest OOP payments of US$282.63 (84.71-369.33) and 277.71 (191.02-874.47), respectively. Overall, 85.3% had a CHE. 203 patients (70.9%) were interviewed after discharge. In this group, 13.8% borrowed money from family, and 12.3% sold personal items of value to pay for their hospital bills.

Conclusion: OOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania.

Keywords: accident & emergency medicine; health economics; trauma management.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Schematic representation of Muhimbili National Hospital (MNH) emergency medicine department (EMD) payment categories.
Figure 2
Figure 2
Flowchart of patient recruitment at the emergency medicine department. OOP, out of pocket.
See this image and copyright information in PMC

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