Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study

Abstract

ObjectiveWe aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs.DesignProspective cohort studySettingEmergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania.ParticipantsInjured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020.MethodsDuring alternating 12-hour shifts, consecutive trauma patients were approached in the ED after stabilisation. A case report form was used to collect social-demographics and patient clinical profile. Total charges billed for ED and in-hospital care and OOP payments were obtained from the hospital billing system. Patients were interviewed by phone to determine the measures they took to pay their bills.Primary outcome measureThe primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income.ResultsWe enrolled 355 trauma patients of whom 51 (14.4%) were insured. The median age was 32 years (IQR 25–40), 238 (83.2%) were male, 162 (56.6%) were married and 87.8% had ≥2 household dependents. The majority 224 (78.3%) had informal employment with a median monthly income of US$86. Overall, 286 (80.6%) had OOP expenses for their care. 95.1% of all patients had an Injury Severity Score <16 among whom OOP payments were US$176.98 (IQR 62.33–311.97). Chest injury and spinal injury incurred the highest OOP payments of US$282.63 (84.71–369.33) and 277.71 (191.02–874.47), respectively. Overall, 85.3% had a CHE. 203 patients (70.9%) were interviewed after discharge. In this group, 13.8% borrowed money from family, and 12.3% sold personal items of value to pay for their hospital bills.ConclusionOOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania.

The older the injured, the worse the outcomes: A comparison of injury patterns and in-hospital outcomes between younger and older adult trauma patients at a tertiary hospital in Northern Tanzania.

“…Among the older adult injury population 88% were hospitalized, and 64% required surgery. This finding shows the increased demand for the healthcare system required to care for older adults, which is consistent with other studies that demonstrated high costs and resources required in older adult trauma care (45)(46)(47). Additionally, our study showed that the majority (60%) of older adults were paying out of pocket for their hospital bills and more than 80% had limited income due to their age and working abilities.…”

Patient-reported outcomes relevant to post-discharge trauma patients in urban India

“…All the participants described how trauma posed a major economic burden in their lives. The out-ofpocket costs, both direct and indirect, especially in LMICs like India, have been well established in literature (62)(63)(64)(65). Being able to return to some form of work was one of the critical outcomes within the economic challenges stated by most participants.…”

Investigating sustainability challenges for the National Health Insurance Fund in Tanzania: a modelling approach

“…One solution to tackle the escalating costs is to raise premiums; however, implementing higher premiums without subsidies for lower income members would hinder efforts to expand coverage 29. The lower premium contribution options for voluntary enrolment may motivate individuals to purchase health insurance especially if OOP costs rise, especially as it could reduce catastrophic health expenditures 30. NHIF has also proposed developing a maximum premium cost for voluntary enrolment to increase marketability of private enrolment, suggesting that increases in primary contribution to address rising cost of care would face major resistance and limit new enrolment 15…”

“…29 The lower premium contribution options for voluntary enrolment may motivate individuals to purchase health insurance especially if OOP costs rise, especially as it could reduce catastrophic health expenditures. 30 NHIF has also proposed developing a maximum premium cost for voluntary enrolment to increase marketability of private enrolment, suggesting that increases in primary contribution to address rising cost of care would face major resistance and limit new enrolment. 15 Mobilising additional public funding to supplement the NHIF finances could alleviate the rising claims Open access costs negatively impacting coverage.…”