Economic Analysis of Pediatric Surgical Financing and Universal Health Coverage in Guatemala

Abstract

Background: Financing of surgical care in low- and middle-income countries remains challenging and poses challenges for implementation of Universal Health Coverage (UHC). This study is an exploration of financing of surgical care for children and alignment of surgical financing within UHC schemes in Guatemala. Our hypothesis is that current financing mechanisms do not address key barriers to provision of surgical care for children within current UHC schemes. Methods: We performed a qualitative analysis of the financing of surgical care for children in the public health system in Guatemala. We surveyed key informants (n=20) in medical, financial, and political sectors to assess mechanisms and operations of financing for pediatric surgical coverage. Qualitative results were triangulated with national financing data and health system reports, with a set of recommendations generated to improve financing of surgical care for children. Results: We found several macro-level challenges to financing for surgical care in Guatemala, including complex political contexts, health finance system fragmentation, and lack of earmarked funding for surgical care. Dominant micro-level challenges include lack of provider agency in financing and patients functioning as financing agents and beneficiaries. Although formal user fees are not used in Guatemala, informal fees for surgical services are common barriers to care. Conclusions: Pediatric surgical financing in Guatemala remains challenging, with little inclusion of surgical care within existing UHC schemes. Recommendations to improve surgical financing include evidence-based financing with provider technical input, strengthening organizational structure for surgical financing, and quantification and reduction of informal user fees through resource pooling between health system actors.