Comparing costs of Overseas Cardiac Treatment between Government, Private Insurance & visiting cardiac teams

Transcription

1 Comparing costs of Overseas Cardiac Treatment between Government, Private Insurance & visiting cardiac teams Presented by WJI at the SSCSIP Stakeholder Reference Group Meeting, Nadi 30 th May 2012

2 Outline of Presentation Background and Objectives Scope of the Study Methodology Limitations Results/Findings Conclusion Questions

3 Background and Objectives Increasing medical expenditures Un-avoidable What are our options? Lobby for more Govt. revenue Explore other HF options Increase donor funding Finding avenues for cost-savings

4 Background and Objectives Avenue for cost-savings Service provision of specialist medical care What are our options? Develop our own expertise Govt. overseas referrals Private health insurance Visiting teams

5 Scope of the Study Comparing the costs of : public referrals, private referrals & visiting teams Cardiac referral cases only Pilot study Fiji, CWM, Suva, OOH Visiting team Year 2011 Input costs

6 Objectives of the Study Objective 1: To estimate the costs incurred by health ministry s due to the presence of a cardiac visiting health team. Objective 2: To estimate the costs spent by the Ministry on the costs of overseas cardiac treatment. Objective 3: To estimate the costs spent by the private sector (via health insurance companies) on the costs of overseas cardiac treatment.

7 Methodology Visiting team Activity based costing (ABC) Government overseas referrals Overseas referrals office Financial accounting system Private overseas referrals Interviews & survey of private insurance companies

8 Limitations Input costs only not outcomes (another study) Aggregated cardiac related cases Private sector results based on interviews Not included all indirect costs of visiting team Indirect costs based on allocation rules Only looked at 1 year 2011 Not looked at costs of providing the service

9 RESULTS AND FINDINGS RESULTS & FINDINGS

10 Objective 1: OOH Visiting Team Costs paid by the Ministry Direct costs Source: MoH FMIS

11 Objective 1: OOH Visiting Team Indirect costs Expense item Costs ($FJD) Details Local HR costs for 14 days for 18 nurses, 2 radiographic officers and 1 admin officer Theatre costs - For the duration of 14 days using the theatre and includes HR, drugs, consumables, utilities 17, k per annum, Admin 18k per annum. There were also a number of doctors involved but we are uncertain about how many and for what duration they worked helping the team, thus their costs are not included here 83, Total estimated annual theatres costs in 2010 costing report was $FJ 2.2m. Estimating visiting team costs using 14 days of total year. In-patient days 43, On average each patient stayed in hospital for approx. 10 days. We estimated for 52 patients at $84.35 per day from Costing Study report. Laboratory costs 13, On average each patient had 2 lab tests done per day during surgery (2 days) and 1 per day during the rest of their stay in $22.14 per test Radiology costs 5, On average 5 x-ray examinations during the 10day stay in $19.61 per exam Transport costs Daily runs from hotel to hospital transporting the visiting team. Estimated at 3 runs per day for 14 $5 per run. Total expenses 163, MoH Report: Costing of health services

12 Objective 1: OOH Visiting Team Direct costs paid by the visiting team Expense item Amount (AUD) Amount (FJD) Medical supplies 46, , Medical supplies implantables* 22, , Insurance volunteers 2, , Insurance equipment 6, , Freight 5, , Travel 63, , Accommodation , Meals General expenses 2, , General supplies Sterile processing costs Pharmacy 7, , Total Expenses 157, , Source: OOH Fiji report to RACS, 2011

13 Objective 1: OOH Visiting Team Indirect costs by the visiting team Role/Skills No. of persons Total days stayed in Fiji Estimated Annual Salary in Aus ($AUD) Estimated salary costs during visit (FJD) Project Leader ,000 5, Cardiac Surgeon ,000 20, Surgeon ,000 13, Assistant Surgeon ,000 18, Anaesthetist ,000 35, Intensivist ,000 25, Perfusionist ,000 19, Anaesthetist RN ,000 13, Theatre RN ,000 23, ICU RN ,000 43, Ward RN ,000 26, Pathology ,000 33, Pharmacist ,000 6, Physiotherapy ,000 15, Sterile processing ,000 4, Educator ,000 2, Transport/Logistics ,000 3, Total ,794.06

14 Objective 1: OOH Visiting Team Total costs of visiting team Amount (FJD) Unit costs (FJD) Direct Costs by MoH 153, Indirect costs by 163, MoH Total MoH costs 317, , Direct costs by 289, Visiting Team Indirect costs by 308, Visiting Team Total Visiting Team 598, , costs Total Cost 696, ,615.15

15 Objective 2: MoH Overseas Referrals Costs of total referrals $FJ Millions Number of cases Cost No. of cases

16 Objective 2: MoH Overseas Referrals Average cost per case Year Costs No. of cases Avg. cost per case Year Costs No. of cases Avg. cost per case , , , , , , , , , , ,541, , , , ,254, , , ,961.34

17 Objective 2: MoH Overseas Referrals Average cost per case $FJ Thousands Number of cases No. of cases Cost per case

18 Objective 2: MoH Total Overseas Referrals Activity Cost ($FJ) How the cost was estimated when not paid by Ministry Treatment 1,586, By knowing the hospital to which the patient was sent together with the condition for which the patient was treated. This was then matched with a similar case that had costs paid by the ministry. Airfares 524, Airfares were obtained from travel agents and estimated for destination and period of travel. Airfares were calculated for two persons since the patient was in all cases accompanied by a family member Visa fees 24, Visa fees were obtained from the consulate offices of the respective countries. Incidental costs 80, These were estimated as 5% of treatment costs which were for other incidental items. Example often the patient may be required to purchase drugs, get a passport, travel from Suva to Nadi, toiletries, etc. Total Costs 2,215, Sum of all the above Costs borne by Ministry Costs borne by patient Total avg. cost per evacuation Total avg. treatment cost per evacuation 1,570, (Approx. 71%) 645, (Approx. 29%) As calculated from the ministry data of overseas referrals Difference between Total costs and Ministry costs 21, Total cost divided by 102 evacuations in , Total treatment cost divided by 102 evacuations in 2011 Ministry avg. cost per 15, Total Ministry cost divided by 102 evacuations in 2011 evacuation Patient College avg. of Medicine, cost per Nursing and 6, Health Sciences, Total patient Fiji cost National divided University, by 102 evacuations in 2011 evacuation

19 Objective 2: MoH Cardiac Overseas Referrals Activity Cost ($FJ) Treatment 770, Airfares 298, Visa fees 12, Incidental costs 38, Total Costs (Sum of all the above) 1,119, Costs borne by Ministry (ministry data of overseas referrals) 770, Costs borne by patient (Total costs minus Ministry costs) 349, Total avg. cost per evacuation (Total cost divided by 56 evacuations in 2011) 19, Total avg. treatment cost per evacuation (Total treatment cost divided by 56 evacuations in 2011) 13, Ministry avg. cost per evacuation (Total Ministry cost divided by 56 evacuations in 2011) 13, Patient avg. cost per evacuation (Total patient cost divided by 56 evacuations in 2011) 6,239.62

20 Objective 3: Private Insurance Overseas Referrals Insurance Companies A B C D Total number of overseas evacuations Country of treatment No. of cardiac related cases Total costs of cardiac cases (FJD) treatment, accommodation, airfares and others NZ India Australia India Australia/NZ India , , , , ,489 96,962 Average total cost per cardiac case (FJD) 64, , , , , , Treatment cost only (FJD) 438, , ,224 22, ,788 60,611 Treatment cost per case (FJD) 54, , , , , , Total number of days patients spent abroad Total Cost per day (FJD) Treatment Cost per day (FJD) 1, , , , , , , , ,

21 Comparing the costs Mode of cardiac health care treatment Govt. referral Visiting Team Private Insurance Country India Fiji NZ/Aust India Cost paid by MoH Patient MoH Visiting Team Insurance Company Avg. unit cost per patient (FJD) 13, , , , , , Total unit cost per patient for scheme (FJD) 19, , , ,641.28

22 Conclusion Treatment via visiting team is the less costly option, although not by a large margin when compared with govt. referrals Overseas evacuation via private insurance is the most costly The Ministry cost per patient for overseas referrals is double the cost per patient when treated by the visiting team Overseas evacuation to India is cheaper that Australia/NZ