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Does community-base...
Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda
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- Koch, Rachel (författare)
- University of Utah,Harvard Medical School
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- Nkurunziza, Theoneste (författare)
- Technical University of Munich
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- Rudolfson, Niclas (författare)
- Lund University,Lunds universitet,Kirurgi och folkhälsa,Forskargrupper vid Lunds universitet,Surgery and public health,Lund University Research Groups,Harvard Medical School
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- Nkurunziza, Jonathan (författare)
- Partners In Health (PIH), Rwanda
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- Bakorimana, Laban (författare)
- Partners In Health (PIH), Rwanda
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- Irasubiza, Holly (författare)
- Partners In Health (PIH), Rwanda
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- Sonderman, Kristin (författare)
- Harvard Medical School
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- Riviello, Robert (författare)
- Harvard Medical School
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- Hedt-Gauthier, Bethany L. (författare)
- Harvard Medical School
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- Shrime, Mark (författare)
- Harvard Medical School
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- Kateera, Fredrick (författare)
- Partners In Health (PIH), Rwanda
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(creator_code:org_t)
- 2022-05-31
- 2022
- Engelska.
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1
- Relaterad länk:
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http://dx.doi.org/10... (free)
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Background: The implementation of community-based health insurance in (CBHI) in Rwanda has reduced out of pocket (OOP) spending for the > 79% of citizens who enroll in it but the effect for surgical patients is not well described. For all but the poorest citizens who are completely subsidized, the OOP (out of pocket) payment at time of service is 10%. However, 55.5% of the population is below the international poverty line meaning that even this copay can have a significant impact on a family’s financial health. The aim of this study was to estimate the burden of OOP payments for cesarean sections in the context of CBHI and determine if having it reduces catastrophic health expenditure (CHE). Methods: This study is nested in a larger randomized controlled trial of women undergoing cesarean section at a district hospital in Rwanda. Eligible patients were surveyed at discharge to quantify household income and routine monthly expenditures and direct and indirect spending related to the hospitalization. This was used in conjunction with hospital billing records to calculate the rate of catastrophic expenditure by insurance group. Results: About 94% of the 340 women met the World Bank definition of extreme poverty. Of the 330 (97.1%) with any type of health insurance, the majority (n = 310, 91.2%) have CBHI. The average OOP expenditure for a cesarean section and hospitalization was $9.36. The average cost adding transportation to the hospital was $19.29. 164 (48.2%) had to borrow money and 43 (12.7%) had to sell possessions. The hospital bill alone was a CHE for 5.3% of patients. However, when including transportation costs, 15.4% incurred a CHE and including lost wages, 22.6%. Conclusion: To ensure universal health coverage (UHC), essential surgical care must be affordable. Despite enrollment in universal health insurance, cesarean section still impoverishes households in rural Rwanda, the majority of whom already lie below the poverty line. Although CBHI protects against CHE from the cost of healthcare, when adding in the cost of transportation, lost wages and caregivers, cesarean section is still often a catastrophic financial event. Further innovation in financial risk protection is needed to provide equitable UHC.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)
Nyckelord
- Developing countries
- Economic crisis
- Health care reform
- Health financing
- Maternity services
- Policy evaluation
Publikations- och innehållstyp
- art (ämneskategori)
- ref (ämneskategori)
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Koch, Rachel
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Nkurunziza, Theo ...
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Rudolfson, Nicla ...
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Nkurunziza, Jona ...
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Bakorimana, Laba ...
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Irasubiza, Holly
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Sonderman, Krist ...
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Riviello, Robert
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Hedt-Gauthier, B ...
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Shrime, Mark
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Kateera, Fredric ...
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