BACKGROUND According to the World Health Organization, essential surgery should be recognized as an essential component of universal health coverage. In Ghana, insurance is associated with a reduction in maternal mortality and improved access to essential medications, but whether it eliminates financial barriers to surgery is unknown. This study tested the hypothesis that insurance protects surgical patients against financial catastrophe. METHODS We interviewed patients admitted to the general surgery wards of Korle-Bu Teaching Hospital (KBTH) between February 1, 2017 - October 1, 2017 to obtain demographic data, income, occupation, household expenditures, and insurance status. Surgical diagnoses and procedures, procedural fees, and anesthesia fees incurred were collected through chart review. The data were collected on a Qualtrics platform and analyzed in STATA version 14.1. Fisher exact and Student T-tests were used to compare the insured and uninsured groups. Threshold for financial catastrophe was defined as health costs that exceeded 10% of household expenditures, 40% of non-food expenditures, or 20% of the individual's income. RESULTS Among 196 enrolled patients, insured patients were slightly older [mean 49 years vs 40 years P < 0.05] and more of them were female [65% vs 41% p < 0.05]. Laparotomy (22.2%) was the most common surgical procedure for both groups. Depending on the definition, 58-87% of insured patients would face financial catastrophe, versus 83-98% of uninsured patients (all comparisons by definition were significant, p < .05). CONCLUSION This study-the first to evaluate the impact of insurance on financial risk protection for surgical patients in Ghana-found that although insured patients were less likely than uninsured to face financial catastrophe as a result of their surgery, more than half of insured surgical patients treated at KBTH were not protected from financial catastrophe under the Ghana's national health insurance scheme due to out-of-pocket payments. Government-specific strategies to increase the proportion of cost covered and to enroll the uninsured is crucial to achieving universal health coverage inclusive of surgical care. TRIAL REGISTRATION Registered at www.clinical trials.gov identifier NCT03604458.

中文翻译：

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保险是否可以保护个人免受手术治疗的灾难性费用？加纳布尔教学医院的加纳国民健康保险计划分析。

背景技术根据世界卫生组织，基本手术应该被认为是全民健康覆盖的重要组成部分。在加纳，保险与降低孕产妇死亡率和增加获得基本药物的机会有关，但是尚不清楚它是否消除了手术的经济障碍。这项研究检验了保险可以保护手术患者免遭经济灾难的假说。方法我们采访了2017年2月1日至2017年10月1日期间进入Korle-Bu教学医院（KBTH）普通外科病房的患者，以获取人口统计学数据，收入，职业，家庭支出和保险状况。手术诊断和程序，手术费和麻醉费通过图表审查收集。数据是在Qualtrics平台上收集的，并在STATA版本14.1中进行了分析。使用Fisher精确和学生T检验比较参保组和未参保组。金融灾难的阈值被定义为医疗费用超过家庭支出的10％，非食品支出的40％或个人收入的20％。结果在196名入组患者中，参保患者年龄稍大（平均49岁vs 40岁，P <0.05），而女性更多（65％vs 41％p <0.05）。两组均最常用的手术方法是剖腹手术（22.2％）。根据定义，有58-87％的参保患者将面临经济灾难，而没有参保的患者有83-98％将面临财务灾难（根据定义，所有比较均具有统计学意义，p <.05）。结论本研究是第一个评估保险对加纳手术患者财务风险保护的影响的研究，发现尽管受保患者因手术而面临财务灾难的可能性比未投保患者低，但一半以上的受保外科手术患者根据加纳的国家健康保险计划，由于现金支付，在KBTH接受治疗的人无法免受金融灾难的影响。特定于政府的策略，要增加覆盖医疗费用的比例并招募未投保的人，这对于实现包括外科护理在内的全民医疗覆盖至关重要。试验注册在www.clinical trial.gov上注册的标识符为NCT03604458。