ASSESSING CATASTROPHIC HEALTHCARE EXPENDITURES IN THE EMERGENCY SURGICAL CARE OF CHILDREN WITH INTUSSUSCEPTION: INSIGHTS FROM A TERTIARY HOSPITAL IN NIGERIA

Abstract

Background: Emergency and essential surgery should be affordable, accessible, and timely. However, this is not the narrative in our setting as patients present late with complications requiring operative treatment which has an attendant healthcare expenditure often tending towards household income depletion. This study assessed the proportion of patients who incurred catastrophic healthcare expenditures following operative treatment for intussusception in our facility. Catastrophic healthcare expenditure was defined as spending >10% of Gross Domestic Product per capita. Health care expenditures were reported in US dollars.

Materials & methods: A prospective cohort study of children 15 years of age and younger who were operatively treated for intussusception at the Paediatric Surgery unit of Federal Medical Centre, Umuahia from January 2017 to December 2020.

Results: Sixty-six (84.6%) out of the 78 children who presented with intussusception within the period had 72 laparotomies. Only 6.1% (4/66) of the patients were enrolled in the National Health Insurance Scheme. The insured patients presented earlier than the uninsured patients (median 4 versus 6 days, p=0.04). The median total health expenditure was $458 (Inter Quartile Range $372.4 ? $707.1) for the uninsured patients. The total health expenditure exceeded 10% of GDP per capita ($209.71) for all the uninsured patients but not for any of the insured patients, giving an overall catastrophic expenditure rate of 93.9% (62/66). The median daily health expenditure was about one-third of 10% of GDP per capita for those who were uninsured.

Conclusion: All the uninsured patients experienced catastrophic health expenditures; with onset from the fourth day on admission. Financial risk protection by implementing payment strategies aimed at reducing user fees to non-catastrophe levels may help.

Keywords: Catastrophic health expenditure; Children; Intussusception; Out-of-pocket payment.