G. A. Anderson1,4, L. Ilcisin4, P. Kayima2, R. Mayanja3, N. Portal Benetiz2, L. Abesiga3, J. Ngonzi3, M. Shrime4 1Massachusetts General Hospital,Surgery,Boston, MA, USA 2Mbarara University Of Science And Technology,Surgery,Mbarara, WESTERN, Uganda 3Mbarara University Of Science And Technology,Obstetrics And Gynecology,Mbarara, WESTERN, Uganda 4Havard Medical School,Global Health And Social Medicine,Boston, MASSACHUSETTS, USA
Introduction: All care delivered at government hospitals in Uganda is provided to patients free of charge. Unfortunately, frequent stock-outs and broken equipment require patients to pay out of pocket for medications, supplies and diagnostics. This is on top of the direct non-medical costs, which can far exceed direct medical costs. Little is known about the amount of money patients have to pay to undergo an operation at government hospitals in Uganda.
Methods: Every patient that was discharged from MRRH after undergoing an operation over a 3-week period in April was approached. Participants were then interviewed, using a validated tool, about their typical monthly expenditures to gauge poverty levels. Next they were asked about the medical costs incurred during the hospitalization. An impoverishing expense was incurred if a patient spent enough money to push them into poverty. A catastrophic expense was incurred if the patient spent more than 10% of their average annual expenditures.
Results: 41% of our patients met the World Bank’s definition of extreme poverty compared with 33% of all Ugandan by Ministry of Finance estimates. After receiving surgical care, one quarter were pushed into poverty by Uganda’s definition and 2 out of every 3 patients became poor by the World Bank’s definition. These devastating financial impacts can also be seen in other ways. Over half of the households in our study had to borrow money to pay for care, 21% had to sell possessions and 17% lost a job as a result of the hospitalization. Only 5% of our patients received some form of charity.
Conclusion: Despite “free care,” receiving an operation at a government hospital in Uganda can result in a severe economic burden to patients and their families. The Ugandan government needs to consider alternative forms of financial protection for its citizens. If surgical care is scaled-up in Uganda the result should not be a scale-up in financial catastrophes. The Ministry of Health and the Ministry of Finance can use our results, and others like these, to help inform decisions regarding healthcare policy and resource allocation.
