M. V. Sgro1, T. Jaraczewski1, A. F. Basmayor1, A. M. Ergete2, K. R. Iverson1, C. M. Dodgion1, M. E. Schroeder1, E. Tesfaye2 1Medical College Of Wisconsin, Department Of Surgery, Milwaukee, WI, USA 2Hawassa University Comprehensive Specialized Hospital, Emergency And Critical Care Medicine, Hawassa, Ethiopia
Introduction: Traumatic injuries account for over five million deaths annually across the globe, with a disproportionately high majority (>90%) of cases occurring in low and middle-income countries (LMICs). In Ethiopia, a low-income country, approximately 24% of residents remain below the national poverty line and unexpected traumas can significantly exacerbate this financial hardship. The proportion of patients who face economic barriers to care and financial risks from treatment costs, particularly trauma patients in LMICs such as Ethiopia, are largely unknown. Aligned with global improvement goals, this project aims to identify prevalent mechanisms of trauma in the region and better understand the financial impact of treatment.
Methods: A validated survey was administered to a convenience sample of patients treated at the region’s primary trauma center from June-August 2023. All patients over age 18 years who were admitted after sustaining a traumatic injury were considered for eligibility. In cases of incapacitation, informed consent and responses were provided by the patient’s family. The progress of treatment and accumulation of inpatient expenditures were tracked daily. General information about demographics and typical financial responsibilities were also obtained to assess three primary factors comprising the endpoint of “economic barriers”: 1) catastrophic expenditure, 2) financial coping mechanisms, and 3) impoverishment status.
Results: Over the course of nine weeks, 100 adult patients were enrolled in the study. The median age of participants was 26 years (18-80), with 83% identifying as male. Injury mechanisms were identified as 62% Motor Vehicle Collision (19% driver, 37% passenger, 6% pedestrian), 25% Assault (11% blunt force, 7% sharp penetrating, 6% gunshot, 1% strangulation), 9% Fall (7% elevation, 2% same level) and 4% Other (3% unspecified, 1% burn). Following standard hospital protocols, trauma patients were required to make a 3,500ETB (~64USD) out-of-pocket cash deposit upon intake. Once the cost of care exceeded the deposit, patients were expected to pay set daily hospital fees and cover other expenditures on a “pay-as-you-go” basis. Of patients with complete financial data, only 10% had insurance, and 26% reported inability to afford all recommended treatment. Hospital expenditures represented a median of 10% a patient's annual household income and 44% had to sell property/belongings or obtain a loan to afford care.
Conclusion: This study illustrates an overview of prevalent traumas in Ethiopia and the substantial financial burdens of care. The ability to pay remains a significant barrier to access safe and timely treatment. While cost mitigating strategies like national insurance plans exist, our study shows that there remains a significant need for greater enrollment and implementation of other innovative solutions to ease the financial burden of seeking care.