Financial impact and healthcare expenditures among surgical patients in Burundi

Background: The largest proportion of people at risk of catastrophic expenditures for surgical care live in low- and middle-income countries. This study aims to evaluate the financial impact among surgical patients at Kibuye Hope Hospital (KHH) in Burundi.

Methods: Data were collected from patients undergoing a surgical procedure at KHH from January to October 2019. A predesigned questionnaire was used to collect information regarding socio-demographics, pre-hospital and hospitalization characteristics, finances, and surgical outcomes. Out-of-pocket (OOP) health expenditure, catastrophic health expenditure (CHE), impoverishing health expenditure (IHE), and financial distress (FD) were summarized.

Results: Of a total of 301 patients, 60% lived below the extreme poverty line ($2.15) at baseline. After surgery, 66% of patients faced CHE, 66% faced FD, and 73% faced IHE. Almost all patients (94%) reported having an insurance plan, although the rate of OOP expenditure was high (98%). The median cost of medications ($215.5) or surgery ($305.6) surpassed the median monthly household expenditure allocated to food ($183.4). The proportion of patients facing extreme poverty at baseline increased from 60% to 96% after direct medical expenses. Many patients reported borrowing money (30%) or selling their land/possessions (46%) to cover OOP expenses.

Conclusions: Most surgical patients at KHH face extremely high risks of CHEs and impoverishment due to OOP expenses for care, despite insurance coverage. The risk of families being forced into poverty and experiencing FD from surgical care are indicators of the lack of effective financial risk protection programs in Burundi.