Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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
Affiliations

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.

PubMed Disclaimer

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

References

    1. Wesson HKH, Boikhutso N, Bachani AM, et al. The cost of injury and trauma care in low- and middle-income countries: a review of economic evidence. Health Policy Plan 2014;29:795–808. 10.1093/heapol/czt064 - DOI - PMC - PubMed
    1. Sawe HR, Mfinanga JA, Mbaya KR, et al. Trauma burden in Tanzania: a one-day survey of all district and regional public hospitals. BMC Emerg Med 2017;17:30. 10.1186/s12873-017-0141-6 - DOI - PMC - PubMed
    1. Prinja S, Jagnoor J, Chauhan AS, et al. Economic burden of hospitalization due to injuries in North India: a cohort study. Int J Environ Res Public Health 2016;13:673. 10.3390/ijerph13070673 - DOI - PMC - PubMed
    1. WHO . Injuries and violence: the facts 2014 World Health Organization, 2014. Available: https://apps.who.int/iris/bitstream/handle/10665/149798/9789241508018_en...
    1. Hemmila MR, Jakubus JL, Maggio PM, et al. Real money: complications and hospital costs in trauma patients. Surgery 2008;144:307–16. 10.1016/j.surg.2008.05.003 - DOI - PMC - PubMed