Skip to main content

Advertisement

SpringerLink
Log in

Financing Pediatric Surgery: A Provider’s Perspective from the Global Initiative for Children’s Surgery

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Half the world’s population is at risk of catastrophic health expenditure (CHE, out-of-pocket spending of more than 10% of annual expenditure) should they require surgery. Protection against CHE is a key indicator of successful health care delivery and has been identified as a priority area by the Global Initiative for Children’s Surgery (GICS). Data specific to pediatric surgical patients is limited. This study examines the financial risks for pediatric surgical patients and their families from a provider’s perspective.

Methods

We surveyed GICS members about the existing financial protection mechanisms and estimated expenditures for their patients. Questions were structured based on the National Surgical, Obstetric and Anesthesia Planning Surgical Indicators and finalized based on multi-institutional consensus between high-income country and low-and middle-income country (LMIC) providers. Chi-squared test, Fisher’s exact test and student’s t-test were used as appropriate.

Results

Among 107 respondents, 72.4% were from low income or lower-middle income (LIC/LMIC) countries, and 55.1% were attending or consultant physicians. Families were most likely to decline surgery in LIC/LMIC due to inability to afford treatment (mean Likert = 3.77 ± 1.06). The odds of incurring CHE after children’s surgery are up to 17 times greater in LIC/LMIC (P = 0.001, unadjusted OR 17.28, 95%CI 2.13–140.02). Over 50% of families of children undergoing major surgery in these settings face CHE. An estimated 5.1% of providers in LIC/LMIC and 56.2% (P < 0.001) of providers in UMIC/HIC reported that families are able to pay for their direct medical costs with the assistance available to them and were more likely to sell assets (74.4% vs. 33.3%, P = 0.005).

Conclusion

Patients in LMICs are at greater risk for CHE and have less financial risk protection than their HIC counterparts. Given this disparity, intervention is needed to make safe surgery affordable for children worldwide.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Boerma T, Eozenou P, Evans D et al (2014) Monitoring progress towards universal health coverage at country and global levels. PLoS Med 11:e1001731

    Article  Google Scholar 

  2. Meara JG, Leather AJ, Hagander L et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet (London, England) 386:569–624

    Article  Google Scholar 

  3. Wagstaff A, Eozenou P, Neelsen S et al (2019) Introducing the world bank’s 2018 health equity and financial protection indicators database. Lancet Global health 7:e22–e23

    Article  Google Scholar 

  4. Jamison DT, Alwan A, Mock CN et al (2018) Universal health coverage and intersectoral action for health: key messages from disease control priorities. Lancet (London, England) 391:1108–1120

    Article  Google Scholar 

  5. Schieber GJ, Gottret P, Fleisher LK et al (2007) Financing global health: mission unaccomplished. Health Aff (Project Hope) 26:921–934

    Article  Google Scholar 

  6. Shrime MG, Dare AJ, Alkire BC et al (2015) Catastrophic expenditure to pay for surgery worldwide: a modelling study. Lancet Global health 3(Suppl 2):S38-44

    Article  Google Scholar 

  7. Population Dynamics UNDoEaSA World Population Prospects 2019., 2019

  8. Ozgediz D, Langer M, Kisa P et al (2016) Pediatric surgery as an essential component of global child health. Semin Pediatr Surg 25:3–9

    Article  Google Scholar 

  9. Ullrich SJ, Kakembo N, Grabski DF et al (2020) Burden and outcomes of neonatal surgery in uganda: results of a 5-year prospective study. J Surg Res 246:93–99

    Article  Google Scholar 

  10. Smith ER, Concepcion TL, Niemeier KJ et al (2019) Is global pediatric surgery a good investment? World J Surg 43:1450–1455

    Article  Google Scholar 

  11. Yap A, Cheung M, Muzira A et al (2021) Best buy in public health or luxury expense?: The cost-effectiveness of a pediatric operating room in Uganda from the societal perspective. Ann Surg 273:379–386

    Article  Google Scholar 

  12. Yap A, Cheung M, Kakembo N et al (2018) From procedure to poverty: out-of-pocket and catastrophic expenditure for pediatric surgery in Uganda. J Surg Res 232:484–491

    Article  Google Scholar 

  13. Banu T, Chowdhury TK, Aziz TT et al (2018) Cost Incurred by the family for surgery in their children: a Bangladesh perspective. World J Surg 42:3841–3848

    Article  Google Scholar 

  14. Smith ER, Concepcion TL, Mohamed M et al (2019) The contribution of pediatric surgery to poverty trajectories in Somaliland. PloS One 14:e0219974

    Article  CAS  Google Scholar 

  15. Nataraja RM, Yin Mar O, Andolfatto L et al (2020) Analysis of financial risk protection indicators in Myanmar for paediatric surgery. World J Surg 44:3986–3992

    Article  Google Scholar 

  16. Global Initiative for Children’s Surgery (2019) A model of global collaboration to advance the surgical care of children. World J Surg 43:1416–1425

    Article  Google Scholar 

  17. Eysenbach G (2004) Improving the quality of web surveys: the checklist for reporting results of internet E-surveys (CHERRIES). J Med Internet Res 6:e34

    Article  Google Scholar 

  18. Pilkington M, Situma M, Winthrop A et al (2018) Quantifying delays and self-identified barriers to timely access to pediatric surgery at Mbarara regional referral hospital Uganda. J Pediatr Surg 53:1073–1079

    Article  Google Scholar 

  19. Concepcion TL, Dahir S, Mohamed M et al (2020) Barriers to surgical care among children in Somaliland: an application of the three delays framework. World J Surg 44:1712–1718

    Article  Google Scholar 

  20. Kakembo N, Godier-Furnemont A, Nabirye A et al (2019) Barriers to pediatric surgical care in low-income countries: the three delays’ impact in Uganda. J Surg Res 242:193–199

    Article  Google Scholar 

  21. Seyi-Olajide JO, Anderson J, Enivwaene AO et al (2020) Catastrophic healthcare expenditure from typhoid perforation in children in Nigeria. Surg Infect 21:586–591

    Article  Google Scholar 

  22. Galukande M, Kituuka O, Elobu E et al (2016) Improving surgical access in rural Africa through a surgical camp model. Surg Res Pract 2016:9021945

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Grabski DF, Kakembo N, Situma M et al (2020) Burden of emergency pediatric surgical procedures on surgical capacity in Uganda: a new metric for health system performance. Surgery 167:668–674

    Article  Google Scholar 

  24. Yousef Y, Lee A, Ayele F et al (2019) Delayed access to care and unmet burden of pediatric surgical disease in resource-constrained African countries. J Pediatr Surg 54:845–853

    Article  Google Scholar 

  25. Muzira A, Kakembo N, Kisa P et al (2018) The socioeconomic impact of a pediatric ostomy in Uganda: a pilot study. Pediatr Surg Int 34:457–466

    Article  Google Scholar 

  26. Prinja S, Jagnoor J, Chauhan AS et al (2015) Estimation of the economic burden of injury in north India: a prospective cohort study. Lancet (London, England) 385(Suppl 2):S57

    Article  Google Scholar 

  27. Rickard JL, Ngarambe C, Ndayizeye L et al (2018) Risk of catastrophic health expenditure in Rwandan surgical patients with peritonitis. World J Surg 42:1603–1609

    Article  CAS  Google Scholar 

  28. Shah PA, Christie SA, Motwani G et al (2020) Financial risk protection and hospital admission for Trauma in Cameroon: an analysis of the Cameroon national trauma registry. World J Surg 44:3268–3276

    Article  Google Scholar 

  29. Prinja S, Jagnoor J, Sharma D et al (2019) Out-of-pocket expenditure and catastrophic health expenditure for hospitalization due to injuries in public sector hospitals in North India. PloS One 14:e0224721

    Article  CAS  Google Scholar 

  30. Nguyen H, Ivers R, Jan S et al (2015) Cost of surgery and catastrophic expenditure in people admitted to hospital for injuries: estimates from a cohort study in Vietnam. Lancet (London, England) 385(Suppl 2):S50

    Article  Google Scholar 

  31. Mock CN, Gloyd S, Adjei S et al (2003) Economic consequences of injury and resulting family coping strategies in Ghana. Accid; Anal Prev 35:81–90

    Article  Google Scholar 

  32. O’Neill KM, Jean RA, Gross CP et al (2020) Financial hardship after traumatic injury: risk factors and drivers of out-of-pocket health expenses. J Surg Res 256:1–12

    Article  Google Scholar 

  33. Scott JW, Raykar NP, Rose JA et al (2018) Cured into destitution: catastrophic health expenditure risk among uninsured Trauma patients in the United States. Ann Surg 267:1093–1099

    Article  Google Scholar 

  34. Obembe T, Fonn S (2020) Affording unavoidable emergency surgical care: the lived experiences and payment coping strategies of households in Ibadan metropolis Southwestern Nigeria. PloS one 15:e0232882

    Article  CAS  Google Scholar 

  35. Krishna A (2010) Who became poor, who escaped poverty, and why? Developing and using a retrospective methodology in five countries. J Policy Anal Manag 29:351–372

    Article  Google Scholar 

  36. Murray SF, Hunter BM, Bisht R et al (2014) Effects of demand-side financing on utilisation, experiences and outcomes of maternity care in low- and middle-income countries: a systematic review. BMC Pregnancy Childbirth 14:30

    Article  Google Scholar 

  37. Shrime MG, Dare A, Alkire BC et al (2016) A global country-level comparison of the financial burden of surgery. Br J Surg 103:1453–1461

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Naomi Wright, Kokila Lakhoo and Marilyn Butler for their aid in survey distribution, as well as William Harkness, Vrisha Madhuri and Coleen Sabatini for their assistance in drafting the survey questionnaire.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Yale New Haven Hospital, 330 Cedar Street, FMB 107, New Haven, CT, 06510, USA

    Sarah J. Ullrich

  2. Department of Pediatric Surgery, Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh

    Nowrin Tamanna, Tasmiah Tahera Aziz & Tahmina Banu

  3. Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    Godfrey Sama Philipo

  4. Division of Pediatric Surgery, National Hospital, Abuja, Nigeria

    Emmanuel A. Ameh

  5. Division of Pediatric Surgery, University of California San Francisco, San Francisco, CA, USA

    Doruk Ozgediz

Authors
  1. Sarah J. Ullrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nowrin Tamanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tasmiah Tahera Aziz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Godfrey Sama Philipo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tahmina Banu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emmanuel A. Ameh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Doruk Ozgediz
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the Global Initiative for Children’s Surgery

Corresponding author

Correspondence to Sarah J. Ullrich.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Informed consent

Informed consent was obtained from all individual participants included in the study. This study was granted exemption by the Yale Human Investigations Committee.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

figure a
figure b
figure c
figure d
figure e
figure f

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ullrich, S.J., Tamanna, N., Aziz, T.T. et al. Financing Pediatric Surgery: A Provider’s Perspective from the Global Initiative for Children’s Surgery. World J Surg 46, 1220–1234 (2022). https://doi.org/10.1007/s00268-022-06463-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-022-06463-7

Search

Navigation