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Does reducing out-of-pocket costs for children's surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study.

Publication ,  Journal Article
Smith, ER; Kapoor, P; Concepcion, T; Ramirez, T; Mohamed, M; Dahir, S; Cotache-Condor, C; Adan Ismail, E; Rice, HE; Shrime, MG
Published in: BMJ Open
May 2, 2023

OBJECTIVES: An estimated 1.7 billion children around the world do not have access to safe, affordable and timely surgical care, with the financing through out-of-pocket (OOP) expenses being one of the main barriers to care. Our study modelled the impact of reducing OOP costs related to surgical care for children in Somaliland on the risk of catastrophic expenditures and impoverishment. DESIGN AND SETTING: This cross-sectional nationwide economic evaluation modelled several different approaches to reduction of paediatric OOP surgical costs in Somaliland. PARTICIPANTS AND OUTCOME MEASURES: A surgical record review of all procedures on children up to 15 years old was conducted at 15 surgically capable hospitals. We modelled two rates of OOP cost reduction (reduction of OOP proportion from 70% to 50% and from 70% to 30% reduction in OOP costs) across five wealth quintiles (poorest, poor, neutral, rich, richest) and two geographical areas (urban and rural). The outcome measures of the study are catastrophic expenditures and risk of impoverishment due to surgery. We followed the Consolidated Health Economic Evaluation Reporting Standards. RESULTS: We found that the risk of catastrophic and impoverishing expenditures related to OOP expenditures for paediatric surgery is high across Somaliland, but most notable in the rural areas and among the poorest quintiles. Reducing OOP expenses for surgical care to 30% would protect families in the richest wealth quintiles while minimally affecting the risk of catastrophic expenditure and impoverishment for those in the lowest wealth quintiles, particularly those in rural areas. CONCLUSION: Our models suggest that the poorest communities in Somaliland lack protection against the risk of catastrophic health expenditure and impoverishment, even if OOP payments are reduced to 30% of surgical costs. A comprehensive financial protection in addition to reduction of OOP costs is required to prevent risk of impoverishment in these communities.

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Published In

BMJ Open

DOI

EISSN

2044-6055

Publication Date

May 2, 2023

Volume

13

Issue

5

Start / End Page

e069572

Location

England

Related Subject Headings

  • Poverty
  • Humans
  • Health Expenditures
  • Family Characteristics
  • Cross-Sectional Studies
  • Cost-Benefit Analysis
  • Child
  • 52 Psychology
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
 

Citation

APA
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Smith, E. R., Kapoor, P., Concepcion, T., Ramirez, T., Mohamed, M., Dahir, S., … Shrime, M. G. (2023). Does reducing out-of-pocket costs for children's surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study. BMJ Open, 13(5), e069572. https://doi.org/10.1136/bmjopen-2022-069572
Smith, Emily R., Pranav Kapoor, Tessa Concepcion, Treasure Ramirez, Mubarak Mohamed, Shukri Dahir, Cesia Cotache-Condor, Edna Adan Ismail, Henry E. Rice, and Mark G. Shrime. “Does reducing out-of-pocket costs for children's surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study.BMJ Open 13, no. 5 (May 2, 2023): e069572. https://doi.org/10.1136/bmjopen-2022-069572.
Smith, Emily R., et al. “Does reducing out-of-pocket costs for children's surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study.BMJ Open, vol. 13, no. 5, May 2023, p. e069572. Pubmed, doi:10.1136/bmjopen-2022-069572.
Smith ER, Kapoor P, Concepcion T, Ramirez T, Mohamed M, Dahir S, Cotache-Condor C, Adan Ismail E, Rice HE, Shrime MG. Does reducing out-of-pocket costs for children's surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study. BMJ Open. 2023 May 2;13(5):e069572.

Published In

BMJ Open

DOI

EISSN

2044-6055

Publication Date

May 2, 2023

Volume

13

Issue

5

Start / End Page

e069572

Location

England

Related Subject Headings

  • Poverty
  • Humans
  • Health Expenditures
  • Family Characteristics
  • Cross-Sectional Studies
  • Cost-Benefit Analysis
  • Child
  • 52 Psychology
  • 42 Health sciences
  • 32 Biomedical and clinical sciences