P. F. Johnston1, J. Badach4, F. Muñoz Córdova3, R. A. Cisneros2, Z. C. Sifri1 1Rutgers New Jersey Medical School,Surgery,Newark, NJ, USA 2Universidad Nacional De Trujillo,Trujillo, LA LIBERTAD, Peru 3Universidad Privada Antenor Orrego,Trujillo, LA LIBERTAD, Peru 4Cooper University Hospital,Surgery,Camden, NJ, USA
Introduction:
In Peru, free health insurance is available to impoverished citizens via the Seguro Integral de Salud (SIS) program. However, significant barriers to accessing care exist, with many relying on Humanitarian organizations for surgical care. The aim of this study is to describe the disease burden and barriers to care faced by Peruvian patients presenting to an international organization for surgery.
Methods:
The International Surgical Health Initiative (ISHI) performs yearly humanitarian general surgical missions to Trujillo, Peru, caring for suitable patients prescreened by local healthcare teams.
On missions in 2016 and 2017, patients referred to ISHI were given paper surveys in Spanish. The survey asked basic demographics, insurance status, barriers to care as well as duration of symptoms and disability associated with the patients’ condition. Survey results were examined for differences in disease burden and barriers to care based on having no insurance versus SIS.
Results:
Sixty-seven out of a total 72 patients receiving care by ISHI completed surveys. The mean age was 46 ± 14 years and 52% were female. Just over half of patients had no insurance (54%), while 40% had SIS, and 6% had other insurance. The most common conditions were gallbladder disease (39%), ventral/umbilical hernia (28%), and inguinal hernia (25%). Mean duration of symptoms was 3.3 ± 5.3 years. Patients averaged 3.4 ± 2.9 doctor/hospital visits prior to presenting to ISHI. Sixty percent reported a limited ability to work, 40% had taken time off school or work, and 51% reported constant pain. A majority of patients (79%) reported cost followed by backlogs (17%) as the major barrier to surgical care.
Patients with no insurance were significantly more likely to have symptoms lasting for longer than 1 year compared to those with SIS. Those enrolled in SIS had more doctor/hospital visits and more commonly reported backlogs as a barrier to care (Table). Age, gender, diagnosis, and disability were not significantly different between the groups.
Conclusion:
Despite SIS being overtly available to all poor Peruvians, over half of the patients presenting to ISHI had no insurance, impeding access to care, resulting in longer duration of symptoms. Those with SIS had greater access to healthcare but still faced barriers to surgical care related to expenditure and backlogs. As a result, common general surgical diseases go untreated for years, resulting in pain, disability, and potential complications.
A larger data set is needed to further examine the extent of the surgical disease burden and shed light on the barriers faced by the impoverished Peruvians. This information may assist ministries of health with the scaling of surgical capacity.
