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Surgical Catastrophic Health Expenditure and Risk Factors for Out-of-Pocket Expenditure at a South African Public Sector Hospital

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Abstract

Background

Worldwide, 3.7 billion people risk financial catastrophe if they require surgery, mostly affecting the poorest populations. Surgical care associated with catastrophic health expenditure (CHE) has not been well-described in the South African context. The objectives of this study were to determine: (1) the proportion of surgical patients at a South African hospital who experienced CHE and impoverishing health expenditure (IHE); and (2) the risk factors for out-of-pocket (OOP) payments.

Methods

A cross-sectional prospective questionnaire was administered to participants admitted for a surgical procedure at New Somerset Hospital, Cape Town. CHE was defined in three ways: (1) 40% or more of capacity-to-pay, (2) 25% of annual household expenditure, or (3) 10% of annual household expenditure. IHE was described as the number of participants who experienced new or worsening impoverishment after surgery.

Results

Two hundred and seventy-four participants were interviewed, and 263 were included in the analysis (4% attrition rate). Two (0.8%) participants experienced CHE. 98.5% of participants spent less than 10% of their annual household expenditure and 43 participants (16.7%) experienced IHE. Risk factors for OOP expenditure were cancer diagnosis (p = 0.0386), an elective procedure (p = 0.0001), and having a limited health insurance plan (p = 0.0492).

Discussion

Most participants undergoing a surgical procedure did not experience CHE. Participants were relatively protected from financial catastrophe owing to subsidized user fees and the provision of transport. However, 17% of patients experienced IHE, suggesting even small payments resulted in impoverishment. Ensuring low financial vulnerabilities around surgical care is an important consideration for national surgical planning in South Africa.

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Acknowledgements

The authors would like to acknowledge the Heads and staff of the following of the following departments at New Somerset Hospital: obstetrics, gynecology, general surgery, urology, and orthopedics.

Funding

This study was funded, in part, by a grant from the University of Cape Town. PN was supported by the National Research Foundation in South Africa. JEA is supported by the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation. MS is supported by the Iris O’Brien Foundation. KC and BA have no sources of funding support to declare.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    P. Naidu

  2. Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    J. E. Ataguba

  3. Institute of Global Surgery, Royal College of Surgeons, Dublin, Ireland

    M. Shrime

  4. Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA

    M. Shrime & B. C. Alkire

  5. Centre for Global Surgery, Department of Global of Health, Tygerberg Hospital, Stellenbosch University, Francie Van Zijl Drive, Cape Town, 7505, South Africa

    P. Naidu & K. M. Chu

Authors
  1. P. Naidu
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  2. J. E. Ataguba
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  3. M. Shrime
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  4. B. C. Alkire
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  5. K. M. Chu
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Corresponding author

Correspondence to P. Naidu.

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Ethics Approval

Ethics approval was obtained from the University of Cape Town (UCT) Human Research Ethics Committee (HREC 619/2018).

Informed consent

Informed consent was obtained from all individual participants included in the study. Participants between 12 and 16 years gave informed consent which was co-signed by their parents or guardians.

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Naidu, P., Ataguba, J.E., Shrime, M. et al. Surgical Catastrophic Health Expenditure and Risk Factors for Out-of-Pocket Expenditure at a South African Public Sector Hospital. World J Surg 46, 769–775 (2022). https://doi.org/10.1007/s00268-022-06472-6

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  • DOI: https://doi.org/10.1007/s00268-022-06472-6

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