Financial Risk of Emergency Abdominal Surgery: Experience from Ethiopia

Background: The Lancet Commission on Global Surgery suggested six indicators every country should use to measure their surgical systems. One of these indicators, catastrophic expenditure (CE), is defined as money paid for service which amounts to more than 10% of the patient’s total annual expenditure, or more than 40% of annual non-food household expenditure. There is no study from Ethiopia that assessed financial risk of emergency abdominal surgery.MethodsUsing a cross sectional study design, financial risk assessment was carried out on 142 patients from Yekatit 12 and Zewditu Memorial hospitals in Addis Ababa, Ethiopia from May 15 to September 15, 2021.ResultsAppendectomy (69.0%), emergency laparotomy (26.1%) and cholecystectomy (4.9%) resulted in mean direct medical expenditures of 111.7USD, 200.70USD and 224.60USD, respectively. Medications and imaging accounted for 60.8% and 13.9% of total treatment cost. By applying the two definitions of catastrophic expenditure, 67.6% and 62.7% of patients sustained CE, respectively. Laparotomy and cholecystectomy resulted in higher rate of CE than appendectomy. Thirty-five (24.6%) patients had some form of insurance, with Community Based Health Insurance being the most common form (57%). Noninsured patients were 10.9 and 9.9 times more likely to sustain CE ( p =  0.002 and p =  0.006 respectively).Conclusion and RecommendationsSignificant financial burden because of emergency abdominal surgery in Addis Ababa is very high. Insurance based financial care is shown to decrease risk of CE significantly. Policy makers should work on expanding insurance and other forms of surgical care financing to a larger proportion of population.