High Out-of-pocket Expenditure: A Burden to Patients Undergoing Coronary Artery Bypass Grafting (CABG) in Sri Lanka

Abstract

Background: The healthcare system in Sri Lanka is the metaphorical “feather in the nation’s cap”. The relationship between social factors that lead to health or chronic diseases has long been recognized in Sri Lanka’s public health care delivery system [1]. The chronic nature of coronary heart disease (CHD) and high out of pocket health spending add a substantial cost burden to the economy of the households. The economic burden of Coronary Artery Bypass Grafting (CABG) care to patients and their families is large [2]. A greater understanding of the financial household cost resulting from CABG care has therefore become necessary to better inform policy [3]. This is the first study done in this research aspect in Sri Lanka. Objective: To determine the demographic and socioeconomic characteristics of patients seeking in-patient services for CABG in Cardiothoracic unit of Teaching Hospital Karapitiya, and to estimate the direct and indirect costs incurred by patients, and coping mechanisms to meet CABG related health costs. Methodology: This is a descriptive cross sectional hospital based study. The study was carried out at Cardiothoracic Unit of Teaching hospital Karapitiya. Data were collected using a pretested interviewer administrated questionnaire. Demographic and socioeconomic characteristics of patients undergone CABG were determined. Direct and indirect components of household costs of hospital stay were estimated with sources of financing. Results: The mean number of hospitalized days was 31. The mean total monthly income of a patient's family was Sri Lankan Rupees (LKR). 26.585 Median household cost of the total hospital stay period was LKR 50,700,00 (Its inter quartile ranged (IQR) between LKR.39.500-69.000), of which 75% were direct costs. The median direct cost was LKR 39350.00 of which majority were cost for food (16.26%). Median indirect cost was LKR 20000.00. It was 25% of total household cost (I US dollar = RS 146.00). Conclusion: The economic burden to the household was mainly due to direct costs incurred for drugs, food, travelling and accommodation. Mean total household cost exceeded the mean monthly income of the households. Hence, there is a need to established and insurance scheme to reduce the cost burden on households.