Economic Burden Of Patients Seeking Neurosurgical Care at Mulago hospital, Kampala, Uganda

Abstract

Background: Private healthcare resources, which include private health insurance agencies, households, facility-based NGOs and private firms cover over 75% of the health expenditure in Uganda. Uganda’s National Health Accounts for the financial year 2009/2010 reported higher spending from private sources than public sources. Further results showed out of pocket expenditure from households was the largest source of funding, contributing 40% to 46% of total health expenditure. The expenditure of a large fraction of household income on health care results in financial risk for most Ugandans and often leaves families impoverished. Therefore, the goal of this study is to describe in detail the burden of cost of patients, using neurosurgery as a proxy. Methods: The study was carried out in Mulago Hospital, Kampala, Uganda. Eligible patients were patients between the ages of 18-90 years of age who had undergone a neurosurgical procedure at Mulago and were on the neurosurgery ward post-surgery. Ultimately, 144 patients agreed to be part of the study. These patients were recruited three nurses who worked on the neurosurgery ward. The data were collected via the use of questionnaires to interview the patients and/or caregivers. We defined catastrophic expenditure as 10% of the household income, while impoverishment was defined as patients living on less than $1 a day. Our analysis was mainly descriptive; however, we ran several regressions to determine predictors of catastrophic expenditure, and impoverishment. Results: 59% of the patients are living below the poverty line. An additional 12% were impoverished by expenditure on healthcare. 93% of the patients experienced financial catastrophe due to the direct costs they incurred in seeking care at the hospital. The patients pay, on average, 27% of the hospital costs incurred in treating the patients. Conclusions: The majority of the patients in our study experienced financial catastrophe in seeking neurosurgical care. Furthermore, most of the patients who sought surgical care were already impoverished. These data underscore the fact that the costs associated with accessing neurosurgical care at Mulago Hospital often result financial hardship on the patients, despite the fact that care in Mulago Hospital is supposed to be free.