Effect of removing the barrier of transportation costs on surgical utilisation in Guinea, Madagascar and the Republic of Congo
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Author
Hamer, Mirjam
Kunz, Lauren M
Claus, Nathan H
Randall, Kirsten
Jean-Baptiste, Joannita H
Maevatombo, Pierre H
Toh, Melissa P S
Biddell, Jasmin R
Bos, Ria
White, Michelle
Note: Order does not necessarily reflect citation order of authors.
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https://doi.org/10.1136/bmjgh-2017-000434Metadata
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Shrime, M. G., M. Hamer, S. Mukhopadhyay, L. M. Kunz, N. H. Claus, K. Randall, J. H. Jean-Baptiste, et al. 2017. “Effect of removing the barrier of transportation costs on surgical utilisation in Guinea, Madagascar and the Republic of Congo.” BMJ Global Health 2 (Suppl 4): e000434. doi:10.1136/bmjgh-2017-000434. http://dx.doi.org/10.1136/bmjgh-2017-000434.Abstract
Background: 81 million people face impoverishment from surgical costs every year. The majority of this impoverishment is attributable to the non-medical costs of care—for transportation, for food and for lodging. Of these, transportation is the largest, but because it is not viewed as an actual medical cost, it is frequently unaddressed. This paper examines the effect on surgical utilisation of paying for transportation. Methods: A hierarchical logistic regression was performed on 2692 patients presenting for surgical care to a non-governmental organisation operating in the Republic of the Congo, Guinea and Madagascar. Controlling for distance from the hospital, age, gender, the need for air travel and time between appointments, the effect of payment for transportation on the surgical no-show rate was evaluated. Results: After adjustment for observed confounders, paying for transportation drops the surgical no-show rate by 45% (OR 0.55; 95% CI 0.40 to 0.77; p<0.001). Age, delay between appointments and the number of hours travelled for surgery also predict surgical no-show. For 28% of no-show patients, the cost of transportation from their homes to a nearby predetermined pick-up point remained a barrier, even when transportation from the pick-up point to the hospital was free. Conclusion: Transportation costs are a significant barrier to surgical care in low-resource settings, and paying for it halves the no-show rate. This finding highlights that decreasing demand-side barriers to surgical care cannot be limited only to the removal of user fees.Other Sources
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5717941/pdf/Terms of Use
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