ArticleBMJ global health2017
Effect of removing the barrier of transportation costs on surgical utilisation in Guinea, Madagascar and the Republic of Congo.
Article in BMJ global health, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed.
- Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda.BMC health services research · 2022Trial
- A Comparative Study of Cleft Management in Different Economic Settings: United States Versus Guatemala.The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association · 2026Article
- Barriers to self-management among patients with permanent pacemakers: a qualitative exploration from the perspective of physicians and nurses.BMC health services research · 2025Article
- Review
- The economic toll of cancer: catastrophic expenditure and impoverishment among lower-income households in Malaysia.BMC public health · 2025Article
- Assessing catastrophic health expenditure and impoverishment in adult asthma care: a cross-sectional study of patients attending six public health clinics in Klang District, Malaysia.BMC health services research · 2024Article
- Transportation and Access to Healthcare in Morocco: An Exploratory Study of Guelmim-Oued Noun Region.Annals of global health · 2024Article
- Decomposing the inequalities in the catastrophic health expenditures on the hospitalization in India: empirical evidence from national sample survey data.Frontiers in public health · 2024Article
- Hand grenade blast injuries in the Eastern Democratic Republic of Congo: a case series of 38 patients.BMC emergency medicine · 2022Article
- Barriers to seeking post-abortion care in Paktika Province, Afghanistan: a qualitative study of clients and community members.BMC women's health · 2021Article
- Article
- A Risk Assessment Tool for Resumption of Research Activities During the COVID-19 Pandemic.Research square · 2020Article
- Article
- Geospatial Analysis of Trauma Burden and Surgical Care Capacity in Teso Sub-region of Eastern Uganda.World journal of surgery · 2019Article
- TRANSPORTATION BARRIERS TO ACCESS HEALTH CARE FOR SURGICAL CONDITIONS IN MALAWI a cross sectional nationwide household survey.BMC public health · 2019Article
- Implementation and evaluation of nationwide scale-up of the Surgical Safety Checklist.The British journal of surgery · 2019Article
- Access to safe surgery.BMJ global health · 2017Article
- Association of Patient Factors and Follow-Up in an International Volunteer Cleft Lip and Palate Repair Clinic in El Salvador.The Journal of craniofacial surgeryArticle
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background81 million people face impoverishment from surgical costs every year. The majority of this impoverishment is attributable to the non-medical costs of care-for transportation, for food and for lodging. Of these, transportation is the largest, but because it is not viewed as an actual medical cost, it is frequently unaddressed. This paper examines the effect on surgical utilisation of paying for transportation.
methodsA hierarchical logistic regression was performed on 2692 patients presenting for surgical care to a non-governmental organisation operating in the Republic of the Congo, Guinea and Madagascar. Controlling for distance from the hospital, age, gender, the need for air travel and time between appointments, the effect of payment for transportation on the surgical no-show rate was evaluated.
resultsAfter adjustment for observed confounders, paying for transportation drops the surgical no-show rate by 45% (OR 0.55; 95% CI 0.40 to 0.77; p<0.001). Age, delay between appointments and the number of hours travelled for surgery also predict surgical no-show. For 28% of no-show patients, the cost of transportation from their homes to a nearby predetermined pick-up point remained a barrier, even when transportation from the pick-up point to the hospital was free.
conclusionTransportation costs are a significant barrier to surgical care in low-resource settings, and paying for it halves the no-show rate. This finding highlights that decreasing demand-side barriers to surgical care cannot be limited only to the removal of user fees.
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