Cost borne by Households of Patients Seeking Care at Cardio Thoracic Unit, Teaching Hospital-Karapitiya, Galle-Sri Lanka

Background: In Sri Lanka today 108 patients die every day due to heart diseases.Their lives can be saved if the number of bypass surgeries carried out on a daily basis is increased by 30 present.The chronic nature of Coronary Heart Disease (CHD) and high out of pocket health spending add a substantial cost burden to the economy of the households.The study assesses the direct and indirect costs incurred by Coronary Artery Bypass Grafting-(CABG) patients, associated factors that increased the household cost and coping mechanisms to meet CABG related health costs.Method: This was a descriptive cross sectional hospital based study.The study was carried out at The Cardio-Thoracic Unit of teaching hospital Karapitiya.Data were collected from patients admitted to undergo the CABG surgery.Data were collected using a pretested interviewer administrated questionnaire.Direct and indirect components of household costs incurred in connection with the CABG process were estimated. Results:The total mean household cost borne by CABG care patients and their households, during the six weeks study period, was estimated at Rs.63,539.64 with (standard deviation Rs.30,995.60 per household), with direct and indirect costs making up 75.05% and 24.95% respectively.According to the study the bulk of the direct cost component consisted of non-medical costs (78.83%) with only 21.17% being direct medical costs.The major part of non-medical cost was on renting a room for relatives while the patient was in the ward.The mean total direct cost was Rs. 47,730.63 and mean total indirect cost was Rs.15, 863.01.A significant positive correlation was found between mean total cost and number of hospital days, distances from home to hospital, hiring a bystander to look after the patient during the hospital stay and travelling cost borne by the household members.Discussion: Direct cost was the major contributor to the household cost of CABG patients, despite the fact that free healthcare ensured that most medical costs were covered by the state.There were only 6% under a health insurance system so the majority (94%) had to bear the entire cost on their own.This created a financial disturbance to households as the majority had family income levels below the mean total household cost. Conclusion:The economic burden imposed by the admission to household was mainly due to direct costs incurred for rent out a room, drug cost and total cost for meals.Direct treatment costs and the indirect costs related to wage loss impose severe financial burden on some households.