Financial burden incurred by patients and their accompanying escorts during a visit to the Emergency Department

Abstract

Background: More than half of South Africans lives below the poverty line. Indirect medical costs can contribute significantly to the financial burden of by patients seeking medical care. Objective: To determine the expenses incurred by patients and/ or their escorts during a visit to the emergency department (ED). Methods: A prospective, cross-sectional and questionnaire-based study was conducted among patients and / or their escorts presenting to an ED in Johannesburg. Results: Of the total 396 participants that completed the questionnaire, 108 (27.2%) did not have any source of income, 146 (36.9%) were the sole breadwinner in their household and 36 (9.1%) belonged to zero-income households Among those earning ≤R2000/month, the mean expenses relating to the ED visit was R240 (SD R372), equating to an average of 33.2% of mean monthly income. Transport costs was the most common expense (n=302, 76.3%), while general practitioner (GP) fees incurred prior to the ED visit accounted for the bulk of the expenses (median R450, IQR 350-820). Participants that earned >R2000/ month were significantly more likely to incur GP fees (p =0.012), while those earning ≤R2000/ month were significantly more likely to take a loan to cover their ED related expenses. Conclusion: A visit to the ED can have a substantial financial impact on patients and their accompanying escorts in South Africa. This study adds to a growing body of literature which indicates that catastrophic healthcare expenditure is a significant problem in South Africa and mostly those already living in poverty. This study shows that both direct as well as indirect costs can contribute to healthcare expenses. Strategies should be aimed at optimising clinical referral systems and improving the services at primary health care facilities.