Analysis of financial risk protection indicators in Sri Lanka for pediatric surgery

Purpose: To investigate the incidence of the Sri Lankan pediatric population who seek emergency surgical services and who are subsequently at risk of impoverishment and catastrophic expenditure. Methods: Prospective data collection at a tertiary pediatric Sri Lankan hospital of direct out-of-pocket (OOP) medical and nonmedical expenses related to pediatric surgical interventions. Catastrophic expenditure and risk of impoverishment were respectively described as expenses superior to 10% of household income and falling below the impoverishment line due to income drop. PPP = purchasing power parity: I$ 3.65, I$ 2.15, and national poverty line (NPL). Distribution of income were estimated using a gamma distribution. Results: Two hundred and twenty pediatric patient surveys completed by carers were collected. Two hundred had complete data for analysis. Ninety-six patients required emergency procedures; the others underwent elective surgeries. The overall direct medical and nonmedical expenses (total direct = TD) mean per patient was I$116.6 and the overall indirect expenses mean per patient was I$94.9. 53.2% were affected by catastrophic expense. 85% (n = 170) of the study population was below the NPL. Receiving surgical care would impact up to 74.1% at the NPL threshold and up to 87.1% at the I$3.65 PPP/day limit. Conclusions: If pediatric surgery care is required, 25.9% of the Sri Lankan population is at risk of impoverishment or catastrophic expenditure. There is need for financial aid.