Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study
ObjectiveWe aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs.DesignProspective cohort studySettingEmergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania.ParticipantsInjured...
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| Published in | BMJ open Vol. 13; no. 1; p. e063297 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
British Medical Journal Publishing Group
31.01.2023
BMJ Publishing Group LTD BMJ Publishing Group |
| Series | Original research |
| Subjects | |
| Online Access | Get full text |
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| Abstract | ObjectiveWe aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs.DesignProspective cohort studySettingEmergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania.ParticipantsInjured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020.MethodsDuring 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 measureThe primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income.ResultsWe 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.ConclusionOOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania. |
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| AbstractList | OBJECTIVEWe aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs. DESIGNProspective cohort study SETTING: Emergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania. PARTICIPANTSInjured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020. METHODSDuring 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 MEASUREThe primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income. RESULTSWe 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. CONCLUSIONOOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania. ObjectiveWe aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs.DesignProspective cohort studySettingEmergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania.ParticipantsInjured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020.MethodsDuring 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 measureThe primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income.ResultsWe 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.ConclusionOOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania. 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 studySetting 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. 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. We aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs. Prospective cohort study SETTING: Emergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania. Injured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020. 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. The primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income. 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. OOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania. |
| Author | Rwegoshora, Shamila Weber, Ellen J Shayo, Frida Sawe, Hendry Robert Kilindimo, Said Sadiq, Abid M Gulamhussein, Masuma A Mfinanga, Juma A Mdundo, Winnie Mussa, Raya Hyuha, Gimbo M |
| AuthorAffiliation | 2 Emergency Medicine , Muhimbili National Hospital , Dar es Salaam , Tanzania, United Republic of 4 Emergency Medicine , University of California San Francisco , San Francisco , California , USA 3 Emergency Medicine , Kilimanjaro Christian Medical University College , Moshi , Kilimanjaro , Tanzania, United Republic of 1 Emegency Medicine , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania, United Republic of |
| AuthorAffiliation_xml | – name: 4 Emergency Medicine , University of California San Francisco , San Francisco , California , USA – name: 3 Emergency Medicine , Kilimanjaro Christian Medical University College , Moshi , Kilimanjaro , Tanzania, United Republic of – name: 1 Emegency Medicine , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania, United Republic of – name: 2 Emergency Medicine , Muhimbili National Hospital , Dar es Salaam , Tanzania, United Republic of |
| Author_xml | – sequence: 1 givenname: Masuma A surname: Gulamhussein fullname: Gulamhussein, Masuma A organization: Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of – sequence: 2 givenname: Hendry Robert orcidid: 0000-0002-0395-5385 surname: Sawe fullname: Sawe, Hendry Robert email: sawe@yahoo.com organization: Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of – sequence: 3 givenname: Said surname: Kilindimo fullname: Kilindimo, Said organization: Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of – sequence: 4 givenname: Juma A surname: Mfinanga fullname: Mfinanga, Juma A organization: Emergency Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania, United Republic of – sequence: 5 givenname: Raya surname: Mussa fullname: Mussa, Raya organization: Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of – sequence: 6 givenname: Gimbo M surname: Hyuha fullname: Hyuha, Gimbo M organization: Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of – sequence: 7 givenname: Shamila surname: Rwegoshora fullname: Rwegoshora, Shamila organization: Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of – sequence: 8 givenname: Frida orcidid: 0000-0002-0779-8209 surname: Shayo fullname: Shayo, Frida organization: Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of – sequence: 9 givenname: Winnie surname: Mdundo fullname: Mdundo, Winnie organization: Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of – sequence: 10 givenname: Abid M orcidid: 0000-0002-7812-8042 surname: Sadiq fullname: Sadiq, Abid M organization: Emergency Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania, United Republic of – sequence: 11 givenname: Ellen J surname: Weber fullname: Weber, Ellen J organization: Emergency Medicine, University of California San Francisco, San Francisco, California, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36720574$$D View this record in MEDLINE/PubMed |
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| Keywords | accident & emergency medicine trauma management health economics |
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| References_xml | – volume: 121 start-page: 481 year: 2017 ident: R28 article-title: Out-of-pocket expenditure and financial protection in the Chilean health care system-a systematic review publication-title: Health Policy doi: 10.1016/j.healthpol.2017.02.013 contributor: fullname: Schmid – volume: 14 year: 2014 ident: R24 article-title: Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey publication-title: BMC Int Health Hum Rights doi: 10.1186/1472-698X-14-5 contributor: fullname: Enemark – volume: 85 year: 2019 ident: R20 article-title: The economic burden of non-fatal musculoskeletal injuries in northeastern Tanzania publication-title: Ann Glob Health doi: 10.5334/aogh.1355 contributor: fullname: Massawe – volume: 18 year: 2020 ident: R26 article-title: Determinants of catastrophic health expenditures in Iran: a systematic review and meta-analysis publication-title: Cost Eff Resour Alloc doi: 10.1186/s12962-020-00212-0 contributor: fullname: Hasanpoor – volume: 11 start-page: 397 year: 2021 ident: R32 article-title: The length of stay and cost of burn patients and the affecting factors publication-title: Int J Burns Trauma contributor: fullname: Bagheri Toolaroud – volume: 13 year: 2016 ident: R3 article-title: Economic burden of hospitalization due to injuries in North India: a cohort study publication-title: Int J Environ Res Public Health doi: 10.3390/ijerph13070673 contributor: fullname: Chauhan – volume: 14 year: 2014 ident: R19 article-title: Determinants of community health fund membership in Tanzania: a mixed methods analysis publication-title: BMC Health Serv Res doi: 10.1186/s12913-014-0538-9 contributor: fullname: Makawia – volume: 17 year: 2017 ident: R2 article-title: Trauma burden in Tanzania: a one-day survey of all district and regional public hospitals publication-title: BMC Emerg Med doi: 10.1186/s12873-017-0141-6 contributor: fullname: Mbaya – volume: 144 start-page: 307 year: 2008 ident: R5 article-title: Real money: complications and hospital costs in trauma patients publication-title: Surgery doi: 10.1016/j.surg.2008.05.003 contributor: fullname: Maggio – volume: 12 year: 2012 ident: R7 article-title: Burden of out-of-pocket expenditure for road traffic injuries in urban India publication-title: BMC Health Serv Res doi: 10.1186/1472-6963-12-285 contributor: fullname: Dandona – volume: 19 year: 2019 ident: R21 article-title: Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system publication-title: BMC Public Health doi: 10.1186/s12889-019-8121-2 contributor: fullname: Wang – volume: 19 year: 2019 ident: R34 article-title: Profile and outcome of patients with emergency complications of renal failure presenting to an urban emergency department of a tertiary hospital in Tanzania publication-title: BMC Emerg Med doi: 10.1186/s12873-019-0229-2 contributor: fullname: Muhanuzi – volume: 17 year: 2022 ident: R25 article-title: Factors associated with catastrophic health expenditure in sub-Saharan Africa: a systematic review publication-title: PLoS One doi: 10.1371/journal.pone.0276266 contributor: fullname: Agu – volume: 88 start-page: 51 year: 2020 ident: R29 article-title: Lifting the burden: state Medicaid expansion reduces financial risk for the injured publication-title: J Trauma Acute Care Surg doi: 10.1097/TA.0000000000002493 contributor: fullname: Stewart – volume: 13 year: 2018 ident: R36 article-title: What interventions are required to reduce road traffic injuries in Africa? 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| Snippet | ObjectiveWe aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic... We aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs.... Objective We aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic... OBJECTIVEWe aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic... Objective We aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic... |
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| SubjectTerms | accident & emergency medicine Adult Cohort analysis Costs Emergency medical care Emergency Medicine Emergency Service, Hospital Emergency services Employment Families & family life Fees & charges Female Health care expenditures health economics Health Expenditures Health insurance Health services Hospitals Humans Income Infectious diseases Informal economy Injuries Insurance coverage Male Medicine Orthopedics Patients Payments Population Poverty Prospective Studies Social workers Socioeconomic factors Tanzania Tertiary Care Centers Trauma trauma management |
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| Title | Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study |
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