Abstract
BackgroundThere has been a significant increase in computed tomography (CT) utilization over the past two decades with the major challenges being a high exposure to ionizing radiation and rising cost. In this study we assess the risk of financial hardship after CT utilization and elaborate on how users adapt and cope in a sub-Saharan context with user fee for services and no national health insurance policy.MethodsWe carried out a sequential explanatory mixed methods study with a quantitative hospital-based survey of CT users followed by in-depth interviews of some purposively selected participants who reported risk of financial hardship after CT utilization. Data was summarized using frequencies, percentages and 95% confidence intervals. Logistic regression was used in multivariable analysis to determine predictors of risk of financial hardship. Identified themes from in-depth interviews were categorized. Quantitative and qualitative findings were integrated.ResultsA total of 372 participants were surveyed with a male to female sex ratio of 1:1.2. The mean age (standard deviation) was 52(17) years. CT scans of the head and facial bones accounted for 63% (95%CI: 59–68%) and the top three indications were suspected stroke (27% [95%CI: 22–32%]), trauma (14% [95%CI: 10–18%]) and persistent headaches (14% [95%CI: 10–18%]). Seventy-two percent (95%CI: 67–76%) of the respondents reported being at risk of financial hardship after CT utilization and predictors in the multivariable analysis were a low socioeconomic status (aOR: 0.19 [95%CI: 0.10–0.38]; p < 0.001), being unemployed or retired (aOR: 11.75 [95%CI: 2.59–53.18]; p = 0.001) and not having any form of health insurance (aOR: 3.59 [95%CI: 1.31–9.85]; p = 0.013). Coping strategies included getting financial support from family and friends, borrowing money and obtaining discounts from the hospital administration and staff.ConclusionNo health insurance ownership, being unemployed or retired and a low socioeconomic status are associated with financial hardship after CT utilization. Diverse coping strategies are utilized to lessen the financial burden, some with negative consequences. Minimizing out-of-pocket payments and/or the direct cost of CT can reduce this financial burden and improve CT access.
Highlights
There has been a significant increase in computed tomography (CT) utilization over the past two decades with the major challenges being a high exposure to ionizing radiation and rising cost
No health insurance ownership, being unemployed or retired and a low socioeconomic status are associated with financial hardship after CT utilization
As findings from this study no health insurance ownership was associated to the risk of financial hardship after CT utilization
Summary
There has been a significant increase in computed tomography (CT) utilization over the past two decades with the major challenges being a high exposure to ionizing radiation and rising cost. Medical imaging has undergone major technological advances in the last two decades with a significant rise in utilization and improved health outcomes for patients [1,2,3,4,5,6,7,8,9]. Computed tomography (CT) has recorded an exponential increase in utilization in hospital emergency departments (EDs) in recent years [4, 10, 11]. The utilization of multislice CT scanners in hospital EDs has been reported to improve on the management of injury, cancer, stroke and cardiac conditions [13,14,15]. The rising cost of advanced CT procedures raises both the direct and indirect cost of care [9,10,11, 24,25,26]
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