Mark G. Shrime|Mirjam Hamer|Swagoto Mukhopadhyay|Lauren Kunz|Nathan H Claus|Kirsten Randall|Joannita H Jean-Baptiste|Pierre H Maevatombo|Melissa P S Toh|Jasmin R Biddell|Ria Bos|Michelle White
Effect of removing the barrier of transportation costs on surgical utilisation in Guinea, Madagascar and the Republic of Congo
Harvard University|Massachusetts Eye and Ear Infirmary|Social Change and Development|University Medical Center|Intensive Care Society|Sisters of Mercy Health System|Harvard University|Social Change and Development|National Institutes of Health|Sisters of Mercy Health System|Sisters of Mercy Health System|Fistula Foundation|Institute for Reproductive Health|Sisters of Mercy Health System|Fistula Foundation|Sisters of Mercy Health System|Sisters of Mercy Health System|Sisters of Mercy Health System|Great Ormond Street Hospital|University College London
81 million people face impoverishment surgical costs every year majority impoverishment attributable nonmedical costs carefor transportation food lodging transportation largest viewed actual medical cost frequently unaddressed paper examines effect surgical utilisation paying transportationa hierarchical logistic regression performed 2692 patients presenting surgical care nongovernmental organisation operating republic congo guinea madagascar controlling distance hospital age gender need air travel time appointments effect payment transportation surgical noshow rate evaluatedafter adjustment observed confounders paying transportation drops surgical noshow rate 45 055 95 ci 040 077 p0001 age delay appointments number hours travelled surgery also predict surgical noshow 28 noshow patients cost transportation homes nearby predetermined pickup point remained barrier even transportation pickup point hospital freetransportation costs significant barrier surgical care lowresource settings paying halves noshow rate finding highlights decreasing demandside barriers surgical care cannot limited removal user fees