High costs push surgical care out of reach

Five billion people globally do not have access to safe, affordable surgery and anaesthesia when they need them, a new study says.

A third of all deaths in 2010 — nearly 17 million lives lost in all — was from conditions treatable with surgery, such as appendicitis, fractures and childbirth complications, the researchers found.

The Global Surgery 2030 Commission, published in The Lancet medical journal and released early on Monday, was written by 25 experts in surgery and anaesthesia, with contributions from more than 110 countries, including India.

Financial pressure

Even among those who are able to access surgery, its costs often lead to financial ruin, the commission said. A quarter of people worldwide who have a surgical procedure incur costs that they cannot afford, pushing them into poverty.

Cost then becomes a significant barrier. Using data from the nationally representative Million Death Study, researchers found that postal code areas with high incidence of acute abdominal mortality in India were more likely to be located further from a hospital capable of providing appropriate emergency surgical care than areas with low mortality. The odds only grew with distance from the hospital.

“In the absence of surgical care, common, easily treatable illnesses become fatal,” said Andy Leather, Director of the King’s Centre for Global Health, King’s College London, and one of the commission’s lead authors.

Scheme subverted

Even when free or subsidised access to surgery is made available by the state, allied costs make utilisation difficult, says a research paper that will be presented at the commission’s launch on Monday. Researchers from the George Institute studied claims in Rajiv Aarogyasri Community Health Insurance Scheme (RACHIS) that provides access to free tertiary medical care across Andhra Pradesh and Telangana.

‘A surprise’

“It came as a surprise to us that despite universal access, the uptake of surgery was still at the level of a low-income country,” Vivekanand Jha, Executive Director, The George Institute for Global Health, India, told The Hindu.

“Just making a scheme available doesn’t automatically mean utilisation will happen. There are a number of factors preventing uptake, including that the scheme only covers the cost of the surgery, while there are a number of steps before the stage of surgery that are not trivial in terms of their implication on cost, and the person needing to be away from his or her livelihood. They might live in remote areas, or other family members might be prioritised,” Dr. Jha said.


Scale-up of levels of access to surgery will need investment, the commission’s authors said. “Although the scale-up costs are large, the costs of inaction are higher and will accumulate progressively with delay,” the commission’s lead author, John Meara, Kletjian Professor in Global Surgery at Harvard Medical School and Associate Professor of Surgery at Boston Children’s Hospital, USA, said.

“Scale-up of surgical and anaesthesia care should be viewed as a highly cost-effective investment, rather than a cost,” he said.

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Printable version | Sep 28, 2021 3:29:27 PM |

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