BMJ Open (Jan 2023)

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

  • Ellen J Weber,
  • Hendry Robert Sawe,
  • Juma A Mfinanga,
  • Masuma A Gulamhussein,
  • Said Kilindimo,
  • Raya Mussa,
  • Gimbo M Hyuha,
  • Shamila Rwegoshora,
  • Frida Shayo,
  • Winnie Mdundo,
  • Abid M Sadiq

DOI
https://doi.org/10.1136/bmjopen-2022-063297
Journal volume & issue
Vol. 13, no. 1

Abstract

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Objective We aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs.Design Prospective cohort studySetting Emergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania.Participants Injured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020.Methods During 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 measure The primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income.Results We 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.Conclusion OOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania.