Does insurance protect individuals from catastrophic payments for surgical care? An analysis of Ghana’s National Health Insurance Scheme at Korle-Bu teaching Hospital

摘要

Background: According to the World Health Organization, essential surgery should be recognized as an essentialcomponent of universal health coverage. In Ghana, insurance is associated with a reduction in maternal mortalityand improved access to essential medications, but whether it eliminates financial barriers to surgery is unknown.This study tested the hypothesis that insurance protects surgical patients against financial catastrophe.Methods: We interviewed patients admitted to the general surgery wards of Korle-Bu Teaching Hospital (KBTH)between February 1, 2017 – October 1, 2017 to obtain demographic data, income, occupation, householdexpenditures, and insurance status. Surgical diagnoses and procedures, procedural fees, and anesthesia feesincurred were collected through chart review. The data were collected on a Qualtrics platform and analyzed inSTATA version 14.1. Fisher exact and Student T-tests were used to compare the insured and uninsured groups.Threshold for financial catastrophe was defined as health costs that exceeded 10% of household expenditures, 40%of non-food expenditures, or 20% of the individual’s income.Results: Among 196 enrolled patients, insured patients were slightly older [mean 49 years vs 40 years P 0.05] andmore of them were female [65% vs 41% p 0.05]. Laparotomy (22.2%) was the most common surgical procedurefor both groups. Depending on the definition, 58–87% of insured patients would face financial catastrophe, versus83–98% of uninsured patients (all comparisons by definition were significant, p .05).Conclusion: This study—the first to evaluate the impact of insurance on financial risk protection for surgicalpatients in Ghana—found that although insured patients were less likely than uninsured to face financialcatastrophe as a result of their surgery, more than half of insured surgical patients treated at KBTH were notprotected from financial catastrophe under the Ghana’s national health insurance scheme due to out-of-pocketpayments. Government-specific strategies to increase the proportion of cost covered and to enroll the uninsured iscrucial to achieving universal health coverage inclusive of surgical care.