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Better access to surgical care is crucial to improve general health status of the population. Despite studies indicate cross country differences according to the general health indicators, there is a scarcity of knowledge about the differences between countries according to the surgical indicators. This study aims to classify countries according to the surgical care indicators and to identify predictors of risk of catastrophic health expenditure for surgical care. Methods: Data came from WHO and WB statistics and totally 177 countries were selected for this study. Variable groups are determined as; total density of medical imaging technologies, workforce distribution in surgical care, number of surgical prodecures and risk of catastrophic expenditure for surgical care. K-means clustering algorithm was used to classify countries according to the surgical indicators. Optimal number of clusters determined by using within cluster sum of squares and scree plot. Silhouette index was used to examine clustering performance. Random Forest decision tree approach was used to determine predictors of the risk for catastrophic expenditure for surgical care. Results: Study results shows that there are four country groups exists according to their surgical care indicators. High and low income countries are in different clusters. The third cluster which consists of low income countries has high Silhouette index value (0.75). Surgeon density and density of the medical imaging technologies are determinators of the risk for catastrophic expenditure for surgical care (AUC=0.82). Conclusions: Study results pose that there is a need for more effective health plans to overcome the differences between countries in terms of surgical care indicators. Determining strategies about distribution of surgical workforce and medical imaging technologies considering accessibility and equality are recommendated for health policy makers.

Worldwide clustering of surgical indicators and predictors of risk of catastrophic expenditure for surgical care