TY  - JOUR
PY  - 2023//
TI  - Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study
JO  - BMJ open
A1  - Gulamhussein, Masuma A.
A1  - Sawe, Hendry Robert
A1  - Kilindimo, Said
A1  - Mfinanga, Juma A.
A1  - Mussa, Raya
A1  - Hyuha, Gimbo M.
A1  - Rwegoshora, Shamila
A1  - Shayo, Frida
A1  - Mdundo, Winnie
A1  - Sadiq, Abid M.
A1  - Weber, Ellen J.
SP  - e063297
EP  - e063297
VL  - 13
IS  - 1
N2  - 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. <br><br>DESIGN: Prospective cohort study SETTING: 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. <br><br>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. <br><br>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. <br><br>CONCLUSION: OOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania.<p />  <p>Language: en</p>
LA  - en
SN  - 2044-6055
UR  - http://dx.doi.org/10.1136/bmjopen-2022-063297
ID  - ref1
ER  -