Out-of-pocket cost of managing sick newborns in Enugu, southeast Nigeria
Out-of-pocket cost of managing sick newborns in Enugu, southeast Nigeria
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DOI：
10.2147/ceor.s54674
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发表时间：
2014-01-01
影响因子：
2.1
通讯作者：
Odetunde, O. Israel
中科院分区：
文献类型：
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作者：
Ekwochi, Uchenna;Osuorah, D. Chidiebere;Odetunde, O. Israel
背景：新生儿疾病通常需要长期住院和专科护理和/或设施，这通常导致巨额医疗费用。在尼日利亚，超过70%的人每天的生活费不足2美元，许多家庭无法负担这些账单。目的：本研究旨在确定尼日利亚东南部埃努古管理新生儿疾病的平均成本和家庭收入在这些疾病上所占的比例。它还试图确定管理新生儿疾病的各个组成部分的费用。方法：这是一项纵向和描述性研究，涉及埃努古州立大学教学医院病儿病房收治的106名新生儿和他们疾病管理中的自付医疗费用。结果：106名新生儿参与了这项研究。所有（100%）医疗账单都是自费支付，其中103笔（97.2%）是灾难性医疗支出（超过家庭月总收入的10%）。平均住院时间和新生儿疾病管理费用分别为12.86 +/- 8.81天和（原文如此）36,382 +/- 19,389.72（223 +/- 119美元）。低、中、高社会经济阶层家庭的这一支出分别占家庭月总收入的157%、71%和25%，平均比例为85%。月总收入低于（原文如此）10,000（61美元）、（原文如此）10,000-49,999（61-306美元）、（原文如此）50,000-100,000（306-612美元）和超过（原文如此）100,000（612美元）的家庭平均将其月收入的683%、108%、54%和20%用于新生儿的疾病。与药物和实验室检查产生的账单相比，医院和水电费在新生儿败血症（（原文如此）23,499 +/- 14,987[144 +/- 92美元]，P=0.001）、低出生体重（（原文如此）39,863 +/- 24,003[224 +/- 147美元]，P=0.001）、严重贫血（（原文如此）40,504 +/- 13,923[248 +/- 85美元]，P=0.001）、新生儿短暂性呼吸急促（（原文如此）10,083 +/- 1,078[62 +/- 7美元]，P=0.001）所产生的总成本中所占比例要大得多。出生窒息（（原文如此）24,398 +/- 14,096[149 +/- 86美元]，P=0.001）和脑膜炎（（原文如此）26,731 +/- 7,675[164 +/- 47美元]，P=0.001），而新生儿黄疸的实验室检查费用明显更高（原文如此）11,690 +/- 3,169[72 +/- 19美元]，P=0.001)。住院时间与总医疗费用呈显著正相关（r=0.897， P=0.001）。结论：新生儿疾病的卫生支出很高，导致该州大多数家庭的灾难性支出。有必要制定有效的健康保险计划，以帮助补贴和缓冲尼日利亚家庭为改善新生儿存活率而进行的这种灾难性和致贫的保健支出。
Background: Neonatal illnesses usually require long hospital stays and specialized care and/or facilities, which usually results in huge medical bills. With more than 70% of people in Nigeria living on less than US$2 per day, these bills are not affordable to many families' livelihoods.Aim: This study aims to determine the average cost of managing neonatal illnesses in Enugu in southeast Nigeria and the proportion of family income spent on these illnesses. It further seeks to ascertain the cost of various components in the management of neonatal diseases.Methods: This is a longitudinal and descriptive study involving 106 newborns admitted to the sick baby unit of the Enugu State University Teaching Hospital and the out-of-pocket medical expenditure in the management of their illnesses.Results: A hundred and six newborns participated in the study. All (100%) medical bills were out-of-pocket payments, and 103 (97.2%) of these were catastrophic health expenditure (more than 10% of total family monthly income). The average duration of hospital stay and cost of managing a neonatal illness was 12.86 +/- 8.81 days and (sic)36,382 +/- 19,389.72 (US$223 +/- 119), respectively. This expenditure amounted to 157%, 71%, and 25% of total monthly family income for the low, middle, and upper socioeconomic class families, respectively, with a mean percentage of 85%. Families with a total monthly income of less than (sic)10,000 (US$61), (sic)10,000-49,999 (US$61-306), and (sic)50,000-100,000 (US$306-612) and more than (sic)100,000 (US$612) on average spent 683%, 108%, 54%, and 20% of their monthly income on their newborn's illness. Hospital and utility bills compared with bills accruing from drug and laboratory investigations account for a significantly larger proportion of total cost incurred in neonatal sepsis ((sic)23,499 +/- 14,987 [US$144 +/- 92], P=0.001), low birth weight ((sic)39,863 +/- 24,003 [US$224 +/- 147], P=0.001), severe anemia ((sic)40,504 +/- 13,923 [US$248 +/- 85], P=0.001), transient tachypnea of the newborn ((sic)10,083 +/- 1,078 [US$62 +/- 7], P=0.001), birth asphyxia ((sic)24,398 +/- 14,096 [US$149 +/- 86], P=0.001), and meningitis ((sic)26,731 +/- 7,675 [US$164 +/- 47], P= 0.001), whereas cost for laboratory investigations was significantly higher for neonatal jaundice ((sic)11,690 +/- 3,169 [US$72 +/- 19], P=0.001). There was a strong positive correlation between duration of hospital stay and total medical cost incurred (r=0.897, P=0.001).Conclusion: Health expenditure on neonatal illness is high and leads to catastrophic expenditure for the majority of households in the state. There is a need for effective health insurance schemes to help subsidize and cushion this disastrous and impoverishing health expenditure on families for improved neonatal survival in Nigeria.