Does insurance protect individuals from catastrophic payments for surgical care? An analysis of Ghana’s National Health Insurance Scheme at Korle-Bu teaching Hospital

Table 5 Cost of Surgical Care and Financial Catastrophe by Insurance Status

	Health insurance status		P-value (Fischer’s exact test)
	Insured	Uninsured	P-value (Fischer’s exact test)
Out of pocket (OOP) expenditures Gh¢ ($USD)
Mean OOP health expenditure (direct medical cost for surgery)	997.1 (203)	2,860.0	<0.001
Mean OOP health expenditures (direct medical cost for ancillary services)	1100 (244)	1,039.0	0.667
Mean OOP non-medical cost/indirect health costs (transportation and lost wages)	243 (54)	218.0	0.657
Total OOP health expenditures (direct & indirect costs)	2238.7 (497)	3,887.5 (863)	<0.001
Financial Catastrophe %^a,b
Percent total OOP out of individual income	40%	61%	0.037
Percent total OOP out of house-hold expenditures	25%	53%	<0.001
Percent total OOP out of subsistence expenditures^c	67%	142%	<0.001
Percentage of individuals incurring catastrophic payments^d
Percentage of individuals incurring catastrophic health payments (income level)	63%	83%	0.017
Percentage of individuals incurring catastrophic health payments (subsistence level)	58%	94%	<0.001
Percentage of individuals incurring catastrophic health payments (house-hold level)	87%	98%	0.008

^aFinancial catastrophe is defined as out of pocket payment for surgery which exceeds; 20% of the respondent’s income, 10% of the household expenditures, or 40% of the household’s net-food expenditures
^bPercent of the respondent’s annual income, house-hold expenditures, or subsistence expenditures that was spent on surgical care . i.e. the insured spent on average 40% of their annual income on surgical care
^cSubsistence expenditures: Total annual household expenditures minus food expenditures
^dPercentage of individuals incurring catastrophic health payments by insurance status at different catastrophic levels i.e. 63% of the insured incurred catastrophic payments for surgical care at the income level

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