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Surgical costs risk financial catastrophe for nearly half of world population

An estimated 16.9 million people died in 2010 because they lacked access to surgical services, which Harvard Medical School researchers say is fixable.

By Stephen Feller

BOSTON, July 20 (UPI) -- For many medical conditions, surgery is the best -- or only -- option available to patients, but it has the potential to wreak financial havoc on those patients' lives.

Nearly half the global population is at risk of dropping below national or international poverty lines, if not being thrown into total financial catastrophe, because of the direct medical costs of surgery, according to a recent study.

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The World Bank, with The Lancet Commission on Global Surgery, has proposed eliminating the risk by 2030 using a combination of integrating and streamlining medical services and working with nations to increase access to university health coverage as ways to reduce consumer costs.

In a 2015 report, the agency estimated 16.9 million people died in 2010 because they needed surgery but could not get it, either because of access or cost, and that at least 77.2 million disability-adjusted life-years could could be prevented with "basic surgical services."

"Five billion people around the world lack access to safe, affordable, and timely surgery," Dr. Mark Shrime, a researcher at Harvard Medical School and lead author of the new study, said in a press release. "Fixing this problem should be a global health priority. However, this research highlights the fact that surgery is expensive and can drive patients into financial destitution."

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For the study, published in the British Journal of Surgery, researchers analyzed publicly available data to estimate the incidence and risk of financial hardship because of surgery for 186 countries based on catastrophic expenditure and impoverishment at the national poverty lines.

The direct cost of surgery put 43.9 percent of the world population at risk of catastrophic expenditure, while an average of 57 percent were at risk of being pushed to live on less than $2 per day.

The researchers expect the new study to help inform the concepts of the World Bank and Commission on Global Surgery, which they did not previously have country-level estimates of the burden of surgical access. While they project potential financial benefits, the researchers also write in the study that policies in individual nations will be needed in order to mitigate the financial risk associated with people keeping themselves alive.

"Scaling up surgical systems to meet the unmet need of the 5 billion should not happen at the cost of scaling up financial catastrophe," Shrime said.

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