Studies from Harvard Medical School Add New Findings in the Area of Cesarean Section (Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda): Surgery – Cesarean Section

Insurance Daily News

2022 JUN 29 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Investigators publish new report on cesarean section. According to news originating from the Harvard Medical School by NewsRx correspondents, research stated, “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%.”

Financial supporters for this research include Foundation For The National Institutes of Health.

Our news reporters obtained a quote from the research from Harvard Medical School: “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). 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. 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%.”

According to the news editors, the research concluded: “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.”

For more information on this research see: Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda. BMC Health Services Research, 2022,22(1):1-11. (BMC Health Services Research - http://bmchealthservres.biomedcentral.com). The publisher for BMC Health Services Research is BMC.

A free version of this journal article is available at https://doi.org/10.1186/s12913-022-08101-3.

Our news journalists report that more information may be obtained by contacting Rachel Koch, Program in Global Surgery and Social Change, Harvard Medical School. Additional authors for this research include Theoneste Nkurunziza, Niclas Rudolfson, Jonathan Nkurunziza, Laban Bakorimana, Holly Irasubiza, Kristin Sonderman, Robert Riviello, Bethany L. Hedt-Gauthier, Mark Shrime, Fredrick Kateera.