{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:09:25Z","timestamp":1788930565039,"version":"build-2803163510"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":50,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/501100022150","name":"Debre Tabor University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022150","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"DOI":"10.1186\/s12893-026-04059-9","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:25:15Z","timestamp":1784615115000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Catastrophic health expenditure associated to bellwether surgery care in Northcentral Ethiopia"],"prefix":"10.1186","volume":"26","author":[{"given":"Atalel Fentahun","family":"Awedew","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"issue":"11","key":"4059_CR1","doi-asserted-by":"publisher","first-page":"2611","DOI":"10.1007\/s00268-016-3614-y","volume":"40","author":"KMGS O\u2019Neill","year":"2016","unstructured":"O\u2019Neill KMGS, Cherian M et al. Bellwether Procedures for Monitoring and Planning Essential Surgical Care in Low- and Middle-Income Countries: Caesarean Delivery, Laparotomy, and Treatment of Open Fractures. World J Surg. 2016;40(11):2611\u20132619. https:\/\/doi.org\/10.1007\/s00268-016-3614-y. PMID: 27351714.","journal-title":"World J Surg"},{"issue":"1","key":"4059_CR2","doi-asserted-by":"publisher","first-page":"e9","DOI":"10.1002\/bjs.9329","volume":"101","author":"BKP Stewart","year":"2014","unstructured":"Stewart BKP, McCord C, Ohene-Yeboah M, Uranues S, Vega Rivera F, Mock C. Global disease burden of conditions requiring emergency surgery. Br J Surg. 2014;101(1):e9\u201322. https:\/\/doi.org\/10.1002\/bjs.9329 . Epub 2013 Nov 25. PMID: 24272924.","journal-title":"Br J Surg"},{"issue":"4","key":"4059_CR3","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1007\/s00268-008-9525-9","volume":"32","author":"PE Farmer","year":"2008","unstructured":"Farmer PE, Kim JY. Surgery and global health: a view from beyond the OR. World J Surg. 2008;32(4):533\u20136. https:\/\/doi.org\/10.1007\/s00268-008-9525-9.","journal-title":"World J Surg"},{"key":"4059_CR4","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.ijoa.2015.09.006","volume":"25","author":"JGLA Meara","year":"2016","unstructured":"Meara JGLA, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Int J Obstet Anesth. 2016;25:75\u20138. https:\/\/doi.org\/10.1016\/j.ijoa.2015.09.006. Epub 2015 Sep 30. PMID: 26597405.","journal-title":"Int J Obstet Anesth"},{"issue":"9","key":"4059_CR5","doi-asserted-by":"publisher","first-page":"2115","DOI":"10.1007\/s00268-015-3153-y","volume":"39","author":"R Price","year":"2015","unstructured":"Price R, Makasa E, Hollands M. World Health Assembly Resolution WHA68.15: Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage\u2014Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services. World J Surg. 2015;39(9):2115\u201325. https:\/\/doi.org\/10.1007\/s00268-015-3153-y.","journal-title":"World J Surg"},{"issue":"11","key":"4059_CR6","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1002\/bjs.10249","volume":"103","author":"MG Shrime","year":"2016","unstructured":"Shrime MG, Dare A, Alkire BC, Meara JG. A global country-level comparison of the financial burden of surgery. Br J Surg. 2016;103(11):1453\u201361. https:\/\/doi.org\/10.1002\/bjs.10249.","journal-title":"Br J Surg"},{"key":"4059_CR7","unstructured":"Ministry of Health, Health Service Quality Directorate (HSQD)(Ethiopia).National Surgical Care Strategic Plan: Saving Lives Through Safe Surgery II (SaLTS II, 2021\u20132025). Addis Ababa, Ethiopia. 2021. https:\/\/ict.moh.gov.et\/en\/elibrary\/guests\/1bea9ace-69e8-4e65-86e4-44c104a09f96. Accessed July 20, 2026."},{"issue":"1","key":"4059_CR8","doi-asserted-by":"publisher","first-page":"S164","DOI":"10.1093\/wber\/lhv009","volume":"29","author":"Z Yilma","year":"2015","unstructured":"Yilma Z, Mebratie A, Sparrow A, et al Impact of Ethiopia\u2019s Community Based Health Insurance on Household Economic Welfare. World Bank Econ Rev. 2015;29(1):S164\u201373. https:\/\/doi.org\/10.1093\/wber\/lhv009.","journal-title":"World Bank Econ Rev"},{"issue":"2","key":"4059_CR9","doi-asserted-by":"publisher","first-page":"e0294215","DOI":"10.1371\/journal.pone.0294215","volume":"21","author":"Y Hailemichael","year":"2026","unstructured":"Hailemichael Y, Eshetu T, Timothewos S, et al. Household costs, catastrophic out-of-pocket payments and impoverishment related to accessing surgical care in rural Ethiopia. PLoS ONE. 2026;21(2):e0294215. https:\/\/doi.org\/10.1371\/journal.pone.0294215.","journal-title":"PLoS ONE"},{"issue":"5","key":"4059_CR10","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1002\/wjs.70343","volume":"50","author":"KR Iverson","year":"2026","unstructured":"Iverson KR, Kifle F, Belay E, Ambese TY, et al. Out-of-Pocket Surgical Costs and Catastrophic Health Expenditure in Ethiopia: Results From a Nationwide Multicenter Cross-Sectional Study. World J Surg. 2026;50(5):1345\u201354. https:\/\/doi.org\/10.1002\/wjs.70343.","journal-title":"World J Surg"},{"key":"4059_CR11","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.amsu.2019.06.003","volume":"43","author":"L Bijlmakers","year":"2019","unstructured":"Bijlmakers L, Wientjes M, Mwapasa G, et al. Out-of-pocket payments and catastrophic household expenditure to access essential surgery in Malawi - A cross-sectional patient survey. Ann Med Surg (Lond). 2019;43:85\u201390. https:\/\/doi.org\/10.1016\/j.amsu.2019.06.003.","journal-title":"Ann Med Surg (Lond)"},{"issue":"5","key":"4059_CR12","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.1007\/s00268-016-3847-9","volume":"41","author":"E Bruno","year":"2017","unstructured":"Bruno E, White MC, Baxter LS, et al. An Evaluation of Preparedness, Delivery and Impact of Surgical and Anesthesia Care in Madagascar: A Framework for a National Surgical Plan. World J Surg. 2017;41(5):1218\u201324. https:\/\/doi.org\/10.1007\/s00268-016-3847-9.","journal-title":"World J Surg"},{"issue":"Suppl 2","key":"4059_CR13","doi-asserted-by":"publisher","first-page":"S50","DOI":"10.1016\/S0140-6736(15)60845-5","volume":"385","author":"H Nguyen","year":"2015","unstructured":"Nguyen H, Ivers R, Jan S, Pham C. Cost of surgery and catastrophic expenditure in people admitted to hospital for injuries: estimates from a cohort study in Vietnam. Lancet. 2015;385(Suppl 2):S50. https:\/\/doi.org\/10.1016\/S0140-6736(15)60845-5.","journal-title":"Lancet"},{"issue":"10","key":"4059_CR14","doi-asserted-by":"publisher","first-page":"e0187293","DOI":"10.1371\/journal.pone.0187293","volume":"12","author":"GA Anderson","year":"2017","unstructured":"Anderson GA, Ilcisin L, Kayima P, et al. Out-of-pocket payment for surgery in Uganda: The rate of impoverishing and catastrophic expenditure at a government hospital. PLoS ONE. 2017;12(10):e0187293. https:\/\/doi.org\/10.1371\/journal.pone.0187293.","journal-title":"PLoS ONE"},{"issue":"10","key":"4059_CR15","doi-asserted-by":"publisher","first-page":"e0258532","DOI":"10.1371\/journal.pone.0258532","volume":"16","author":"AJ van Duinen","year":"2021","unstructured":"van Duinen AJ, Westendorp J, Ashley T, et al. Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone: An evaluation of the free health care initiative. PLoS ONE. 2021;16(10):e0258532. https:\/\/doi.org\/10.1371\/journal.pone.0258532.","journal-title":"PLoS ONE"},{"issue":"3","key":"4059_CR16","doi-asserted-by":"publisher","first-page":"znaf289","DOI":"10.1093\/bjs\/znaf289","volume":"113","author":"TTK Anyomih","year":"2026","unstructured":"Anyomih TTK, Agbeko AE, Aregawi AB, et al. Systematic review of the Lancet Commission on Global Surgery indicators with quality assessment of modelled estimates. Br J Surg. 2026;113(3):znaf289. https:\/\/doi.org\/10.1093\/bjs\/znaf289.","journal-title":"Br J Surg"},{"issue":"1","key":"4059_CR17","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s12913-020-4887-2","volume":"20","author":"J Okoroh","year":"2020","unstructured":"Okoroh J, Sarpong DO, Essoun S, Riviello R, Harris H, Weissman JS. Does insurance protect individuals from catastrophic payments for surgical care? An analysis of Ghana\u2019s National Health Insurance Scheme at Korle-Bu teaching Hospital. BMC Health Serv Res. 2020;20(1):45. https:\/\/doi.org\/10.1186\/s12913-020-4887-2.","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"4059_CR18","doi-asserted-by":"publisher","first-page":"e0146508","DOI":"10.1371\/journal.pone.0146508","volume":"11","author":"F Masiye","year":"2016","unstructured":"Masiye F, Kaonga O, Kirigia JM. Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia. PLoS ONE. 2016;11(1):e0146508. https:\/\/doi.org\/10.1371\/journal.pone.0146508.","journal-title":"PLoS ONE"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-026-04059-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-026-04059-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-026-04059-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:56:10Z","timestamp":1788929770000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12893-026-04059-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4059"],"URL":"https:\/\/doi.org\/10.1186\/s12893-026-04059-9","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"assertion":[{"value":"7 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethics approval was obtained from the Institutional Review Board of the Debre Tabor University. Informed consent was obtained from all participants. The study adhered with Declaration of Helsinki principles.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"604"}}