Financial Risk Protection for Neurosurgical Care in Indonesia and the Philippines: A Primer on Health Financing for the Global Neurosurgeon

Abstract

Which conditions treated by neurosurgeons cause the worst economic hardship in low middle-income in countries? How can public health financing be responsive to the inequities in the delivery of neurosurgical care? This review article frames the objectives of equity, quality, and efficiency in health financing to the goals of global neurosurgery. In order to glean provider perspectives on the affordability of neurosurgical care in low-resource settings, we did a survey of neurosurgeons from Indonesia and the Philippines and identified that the care of socioeconomically disadvantaged patients with malignant intracranial tumors were found to incur the highest out-of-pocket expenses. Additionally, the surveyed neurosurgeons also observed that treatment of traumatic brain injury may have to require greater financial subsidies. It is therefore imperative to frame health financing alongside the goals of equity, efficiency, and quality of neurosurgical care for the impoverished. Using principles and perspectives from managerial economics and public health, we conceptualize an implementation framework that addresses both the supply and demand sides of healthcare provision as applied to neurosurgery. For the supply side, strategic purchasing enables a systematic and contractual management of payment arrangements that provide performance-based economic incentives for providers. For the demand side, conditional cash transfers similarly leverages on financial incentives on the part of patients to reward certain health-seeking behaviors that significantly influence clinical outcomes. These health financing strategies are formulated in order to ultimately build neurosurgical capacity in LMICs, improve access to care for patients, and ensure financial risk protection.

Traumatic tension pneumocephalus: a case report and perspective from Indonesia

“…In his initial state, the patient presented in this report did not exhibit any neurological deficits, which contributes to his refusal for emergency surgical intervention despite being given thorough explanation by the on call neurosurgeon. Lack of comprehension regarding course of the disease and importance of treatment, paired with patient’s financial instability, are common socioeconomic issues causing hesitance to receive medical care in LMICs ( 11 , 17 ). Considering the imminent life threat identified through head CT, the neurosurgeon persuaded the patient to agree to a 48-h hospital admission for monitoring.…”

“…Delays in providing best neurotrauma care in LMICs is highly influenced by patient-related barriers ( 10 , 11 , 17 ). Presence of stigma and traditional beliefs concerning disease processes, absence of health education and social support, together with possibility of patient’s financial detriments due to seeking care, are few of the main problems encountered in daily medical practice of developing countries, including Indonesia ( 11 , 17 , 22 ). Limited understanding of medical problems where certain perspective that the disease contracted does not have significant negative impact on patients’ lives results in reluctance for receiving medical care ( 23 ).…”

“…Limited understanding of medical problems where certain perspective that the disease contracted does not have significant negative impact on patients’ lives results in reluctance for receiving medical care ( 23 ). The fact that current demography of LMICs TBI patients are dominated by breadwinners of the family consequently adds additional hindrance, since hospitalization would result in income regression and unemployment ( 12 , 13 , 17 , 24 ). A survey involving Indonesian neurosurgeons found that 27.3% of its participants regarded TBI as the worst cause for economic hardship among patients.…”

“…A survey involving Indonesian neurosurgeons found that 27.3% of its participants regarded TBI as the worst cause for economic hardship among patients. Even though public neurosurgical centers in Indonesia are mandated by legislation to provide healthcare at minimum or zero cost, seeking healthcare would put the poverty-ridden population under serious financial burden due to transportation costs and caregiving expenses ( 17 ).…”

Current trends and challenges: The landscape of perioperative mortality in intracranial surgeries in low‐ and middle‐income settings: A narrative review

“…In LMIC neurosurgical settings, addressing financial barriers is paramount to achieving equitable healthcare access 33 . Policymakers should devise fiscal strategies to alleviate neurosurgical healthcare costs, ensuring equitable access across socioeconomic lines.…”