Financial Burden Associated with Attendance at a Public Hospital Emergency Department in Johannesburg

Overview

Journal Afr J Emerg Med

Publisher Elsevier

Specialty Emergency Medicine

Date 2022 Mar 7

PMID 35251920

Authors

James Morrow

Abdullah E Laher

Affiliations

Soon will be listed here.

Abstract

Introduction: More than half of South Africans live below the poverty line. Indirect medical costs can contribute significantly to the financial burden of patients seeking medical care. The aim of this study was to determine the expenses incurred by patients and/or their escorts during a visit to the emergency centre (EC).

Methods: Patients and/or their escorts presenting to an EC in Johannesburg were asked to complete the study questionnaire relating to expenses incurred during a visit to the EC.

Results: Of the total 396 participants that completed the questionnaire, 108 (27.2%) did not have any source of income, 146 (36.9%) were the sole breadwinner in their household and 36 (9.1%) belonged to zero-income households. Among those earning ≤R2000 per month, the mean expenses relating to the EC visit was R240 (SD R372), equating to an average of 33.2% of mean monthly income. Transport costs were the most common expense (n=302, 76.3%), while general practitioner (GP) fees incurred prior to the EC visit accounted for the bulk of the expenses (median R450, IQR 350-820). Participants that earned >R2000 per month were significantly more likely to incur GP fees (p =0.012), while those earning ≤R2000 per month were significantly more likely to take a loan to cover EC related expenses (p =0.014).

Conclusion: A visit to the EC can have a substantial financial impact on patients and their accompanying escorts in South Africa. Strategies should be aimed at identifying and assisting those that are in need of financial assistance to cover indirect healthcare costs.

References

Etlouba Y, Laher A, Motara F, Moolla M, Ariefdien N . First Presentation with Psychotic Symptoms to the Emergency Department. J Emerg Med. 2018; 55(1):78-86. DOI: 10.1016/j.jemermed.2018.04.014. View

Platt E, Doe M, Kim N, Chirengendure B, Musonda P, Kaja S . Economic impact of surgery on households and individuals in low income countries: A systematic review. Int J Surg. 2021; 90:105956. DOI: 10.1016/j.ijsu.2021.105956. View

Masiye F, Kaonga O, Kirigia J . Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia. PLoS One. 2016; 11(1):e0146508. PMC: 4721670. DOI: 10.1371/journal.pone.0146508. View

Girdwood S, Govender K, Long L, Miot J, Meyer-Rath G . Primary healthcare delivery models for uninsured low-income earners during the transition to National Health Insurance: Perspectives of private South African providers. S Afr Med J. 2019; 109(10):771-783. DOI: 10.7196/SAMJ.2019.v109i10.13930. View

Mojaki M, Basu D, Letskokgohka M, Govender M . Referral steps in district health system are side-stepped. S Afr Med J. 2011; 101(2):109. DOI: 10.7196/samj.4385. View

Barennes H, Frichittavong A, Gripenberg M, Koffi P . Evidence of High Out of Pocket Spending for HIV Care Leading to Catastrophic Expenditure for Affected Patients in Lao People's Democratic Republic. PLoS One. 2015; 10(9):e0136664. PMC: 4556637. DOI: 10.1371/journal.pone.0136664. View

Rodwin V . The health care system under French national health insurance: lessons for health reform in the United States. Am J Public Health. 2003; 93(1):31-7. PMC: 1447687. DOI: 10.2105/ajph.93.1.31. View

Yousefi M, Assari Arani A, Sahabi B, Kazemnejad A, Fazaeli S . Household Health Costs: Direct, Indirect and Intangible. Iran J Public Health. 2015; 43(2):202-9. PMC: 4450688. View

Grol R, Giesen P, van Uden C . After-hours care in the United Kingdom, Denmark, and the Netherlands: new models. Health Aff (Millwood). 2006; 25(6):1733-7. DOI: 10.1377/hlthaff.25.6.1733. View

10.

ONeill K, Mandigo M, Pyda J, Nazaire Y, Greenberg S, Gillies R . Out-of-pocket expenses incurred by patients obtaining free breast cancer care in Haiti: A pilot study. Surgery. 2015; 158(3):747-55. DOI: 10.1016/j.surg.2015.04.040. View

11.

Knaul F, Wong R, Arreola-Ornelas H, Mendez O . Household catastrophic health expenditures: a comparative analysis of twelve Latin American and Caribbean Countries. Salud Publica Mex. 2011; 53 Suppl 2:s85-95. View

12.

Musakwa N, Bor J, Nattey C, Lonnermark E, Nyasulu P, Long L . Perceived barriers to the uptake of health services among first-year university students in Johannesburg, South Africa. PLoS One. 2021; 16(1):e0245427. PMC: 7822246. DOI: 10.1371/journal.pone.0245427. View

13.

McIntyre D, Thiede M, Dahlgren G, Whitehead M . What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?. Soc Sci Med. 2005; 62(4):858-65. DOI: 10.1016/j.socscimed.2005.07.001. View

14.

Maphumulo W, Bhengu B . Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis. 2019; 42(1):e1-e9. PMC: 6556866. DOI: 10.4102/curationis.v42i1.1901. View

15.

Castillo-Riquelme M, McIntyre D, Barnes K . Household burden of malaria in South Africa and Mozambique: is there a catastrophic impact?. Trop Med Int Health. 2008; 13(1):108-22. DOI: 10.1111/j.1365-3156.2007.01979.x. View

16.

Wagner R, Bertram M, Gomez-Olive F, Tollman S, Lindholm L, Newton C . Health care utilization and outpatient, out-of-pocket costs for active convulsive epilepsy in rural northeastern South Africa: a cross-sectional Survey. BMC Health Serv Res. 2016; 16:208. PMC: 4924265. DOI: 10.1186/s12913-016-1460-0. View

17.

Chimbindi N, Bor J, Newell M, Tanser F, Baltussen R, Hontelez J . Time and Money: The True Costs of Health Care Utilization for Patients Receiving "Free" HIV/Tuberculosis Care and Treatment in Rural KwaZulu-Natal. J Acquir Immune Defic Syndr. 2015; 70(2):e52-60. PMC: 4748708. DOI: 10.1097/QAI.0000000000000728. View

18.

Barasa E, Maina T, Ravishankar N . Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya. Int J Equity Health. 2017; 16(1):31. PMC: 5294805. DOI: 10.1186/s12939-017-0526-x. View

19.

van Mierlo T, Hyatt D, Ching A . Employing the Gini coefficient to measure participation inequality in treatment-focused Digital Health Social Networks. Netw Model Anal Health Inform Bioinform. 2016; 5(1):32. PMC: 5082574. DOI: 10.1007/s13721-016-0140-7. View

20.

Bhuiyan M, Luby S, Alamgir N, Homaira N, Sturm-Ramirez K, Gurley E . Costs of hospitalization with respiratory syncytial virus illness among children aged <5 years and the financial impact on households in Bangladesh, 2010. J Glob Health. 2017; 7(1):010412. PMC: 5502704. DOI: 10.7189/jogh.07.010412. View