ANNEXURE J THE COST OF MEDICAL AND REHABILITATION CARE FOR ROAD ACCIDENT VICTIMS AT PUBLIC HOSPITALS

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1 HERBST - COST OF CARE 547 ANNEXURE J THE COST OF MEDICAL AND REHABILITATION CARE FOR ROAD ACCIDENT VICTIMS AT PUBLIC HOSPITALS DR A J HERBST May 2002

2 ROAD ACCIDENT FUND COMMISSION REPORT 2002 VOLUME 3 THE COST OF MEDICAL AND REHABILITATION CARE FOR ROAD ACCIDENT VICTIMS AT PUBLIC HOSPITALS INTRODUCTION BACKGROUND The Road Accident Fund (RAF) is a statutory organisation established in terms of the Road Accident Fund Act (Act No. 56 of 1996). It reports to the Minister of Transport and was established for the purpose of paying compensation for loss or damage wrongfully caused by the driving of motor vehicles. At the present time, the RAF is obliged in law to make good any financial loss sustained by the victim of the road accident. This means that victims of road accidents are entitled to claim "medical expenses" from the RAF. The Road Accident Fund Commission (RAFC) was appointed in June 1999 (Road Accident Fund Commission Act, Act No. 71 of 1998) to inquire into and to make recommendations as to a "reasonable, affordable, equitable and sustainable system" for the payment of compensation or benefits to the victims of road accidents in South Africa. There are currently about 6 million licensed drivers and about 6,73 million licensed and registered vehicles on South Africa s roads. The annual vehicle/km travelled on SA roads is estimated at about million. There are currently about traffic crashes a year, resulting in approximately deaths, serious injuries and minor injuries 1 per annum. TABLE 1 COMPARISON OF SOUTH AFRICAN ROAD ACCIDENT FATALITY RATES Country Deaths per Deaths per vehicles population Japan Australia Germany Canada USA South Africa Table 1 compares South African road accident fatality risks to a few other countries showing that the death rate per registered vehicle in South Africa is very high compared to the rates in developed countries. Road accident victims receive care from both the private and public health care sectors in the country. The majority (± 80%) of South Africans receive their health care from the public health care system 2.

3 HERBST - COST OF CARE 549 Over the past four years the Department of Health has developed a uniform patient fee schedule (UPFS). The UPFS is used to bill externally funded patients at public hospitals and as a basis for calculating subsidised patient fees. The UPFS has been calibrated to approximate the cost of rendering the services represented by the fee schedule. However, the fee schedule has been designed to be simple to use and to hide the huge detail and complexity of modern health care services. The UPFS covers all aspects of hospital care including the emergency transportation of accident victims and is currently in use in 8 of the 9 provinces. The 2001 edition of the UPFS is used in all calculations. OBJECTIVES The purpose of the study is to assist the Road Accident Fund Commission to calculate the cost of rendering medical and rehabilitation care for road accident victims at provincial hospitals. The specific objectives of the study are: 1) To estimate the number and type of road accident victims that will require care and rehabilitation at provincial hospitals. 2) To identify typical care and rehabilitation packages at provincial hospitals for road accident victims. 3) To cost the typical care and rehabilitation packages using the UPFS. 4) To estimate the total cost of medical and rehabilitation care for road accident victims at provincial hospitals. METHODOLOGY ANALYSIS AND CODING OF HSRC INJURY DATABASE The Human Sciences Research Council under the leadership of Elize van Zyl analysed a sample of claims finalised by the RAF during the 1998/99 financial year 3. A sample size of cases from a total of finalised where captured for the analysis. Injuries to cases were coded according to the Australian Worksafe System. The system codes the anatomical location of the injury and the nature of the injury (fracture, contusion, etc). Multiple injuries per case can be coded, but with the most serious injury identified as the primary injury. A breakdown of the coded primary injuries is given in Table 2. The most common injury type is fractures, with fractures of the lower limb the single most common injury body part combination. Sprain of the head and neck region is the second most common injury body part combination. Unfortunately the injury type body part combination coding is not commonly used or recorded during health care delivery, which makes it difficult to relate this information to health care utilisation and cost data. It is necessary to recode the information to a more commonly used diagnosis classification system such as the International Classification of Disease (ICD) classification. The injuries were recoded into the 9th edition of the ICD. The resulting breakdown by ICD-9 group is listed in Table 3 (a detail breakdown is given in Appendix A). The individual ICD-9 diagnoses are too cumbersome to work with and the

4 550 ROAD ACCIDENT FUND COMMISSION REPORT 2002 VOLUME 3 sample size per ICD-9 diagnosis is also too low for modelling purposes. ICD-9 codes were grouped together using the groups given in the Injury Cost Model of the US Consumer Product Safety Commission 4. Individual diagnoses within each group are expected to have a similar profile of service utilisation. TABLE 2 WEIGHTED PRIMARY INJURY FREQUENCY Injury Type Head & Trunk Upper Lower Unspeci- Total % Neck Limb Limb fied Fracture % Sprain % Superficial injury % Contusion % Unspecified % Open wound % Dislocation % Amputation % Burns % Foreign body % Total Percentage 59% 22% 19% 46% 13% BASE DATA FOR SERVICE UTILISATION PROFILE Three possibilities were considered as source of base data to determine the service utilisation profile per injury: 1) Service profile of claims submitted to the RAF. 2) Expert consensus of required care package per injury. 3) Other sources of historical data on service utilisation by injured individuals. Option 1 was considered problematical due to the possible distortion that could be introduced by the claims process itself and the difficulty in obtaining data in a computer readable format. Option 2 was originally considered, but after recoding the injuries to ICD diagnoses it was considered impractical to obtain consensus profiles on 135 different diagnoses. The South African Military Health Services (SAMHS) has been using a fully computerised medical record system for the past twenty years and has accumulated a vast database of services rendered to military personnel and their dependants. Access was granted to this database originally in the context of the UPFS development and that same access was used in obtaining the injury service profiles on this occasion.

5 HERBST - COST OF CARE 551 TABLE 3 PRIMARY INJURY FREQUENCY BY ICD-9 GROUP ICD 9 Group Frequency Sprain back Fracture pelvis/lower limb Superficial injury head, face/neck Superficial injury, other/unspecified/multiple Contusions Fracture skull/face, excl nose Fracture upper limb Fracture chest, clavicula/scapula Fracture/dislocation vertebral column/spinal cord Head injury, other Concussion Internal injury Injury, other and unspecified Sprain ankle/foot Sprain lower limb Open wound head, face/neck Dislocation 861 Sprain upper limb 695 Open wound lower limb 601 Fracture hand 444 Amputation arm/leg 183 Open wound other/upper arm 174 Sprain wrist/hand 148 Nerve damage 128 Sprain other/ill defined 121 Burn, all other 109 Open wound finger 85 Open wound hand 77 Foreign body eye 73 Open wound arm 48 Amputation finger/toe 48 Burn head, face/neck 21 Total SAMHS DATASET The dataset was constructed by identifying all cases with a consultation with a diagnosis signifying an injury (The cause of the injury is not restricted to motor vehicle injuries only) during From this index consultation all admissions, theatre procedures, medical imaging procedures, laboratory investigations, and medication prescriptions were extracted for a full year after the date of the index consultation. Specifically the datasets used were: 1) Consultations. For each consultation the date, clinical department responsible and diagnosis code/s were recorded. A total of records were received.

6 552 ROAD ACCIDENT FUND COMMISSION REPORT 2002 VOLUME 3 2) Admissions. For each admission the admission and discharge date, clinical discipline, location of stay in the hospital, diagnosis code/s and the numbers of days spent in a general ward and in intensive care were recorded. A total of records were received. 3) Theater procedures. The type of procedure, clinical department responsible and date of the procedure were recorded. A total of records were received. 4) Imaging procedures. The type of imaging procedure, the number of Xray plates, the requesting clinical department and the date of the procedure. A total of records were received. 5) Medication. The number of items on the script, the cost of the script calculated at government tender price, the requesting department and the date of the script. A total of records were received. 6) Laboratory. The type of test requested (biochemistry, haematology, serology, microbiology or virology), the requesting department and the total cost of the tests and the date of the test. A total of records were received. DATA PROCESSING The data was received in delimited text format. The data was then imported in to a Microsoft Access database for further manipulation: 1) Case Extraction. A record for each case was created to which all other data was linked. A total of cases were identified. 2) Procedure recoding. All procedures were recoded from the ICD-9 procedure code to and equivalent Board of Health Care Funders (BHF) item code. This process was difficult, because the ICD-9 procedures can be imprecise (eg other procedure on head and neck), whilst the BHF items all refer to very specific operations. In these cases the most common or relevant code from an injury perspective was used. 3) Image procedure recoding. A similar process to 2, except in general the SAMHS imaging codes have a more direct relationship to the equivalent BHF imaging item code. The recoding in 2 & 3 was necessary to derive the UPFS category for each procedure. RECORD LINKAGE As a next step all the services (consultations, admissions, procedures, medications and laboratory tests) related to an injury incident had to be linked on the basis of the available information. A small computer application was developed to assist with this process and 200 cases manually linked to gain experience with the dataset and to use as a benchmark for the automated record linkage process. The automated linkage procedure proceeded as follows: The index consultation for each case was identified. Cases where the index consultation was a follow-up or rehabilitation consultation were excluded. These

7 HERBST - COST OF CARE 553 cases do not represent a complete injury case they were identified later in the course of the injury treatment. All procedures, prescriptions and laboratory tests that took place within three days of the date of the selected consultation (starting on the day before the consultation) were then linked to the index consultation. All admissions that took place within 7 days (starting on the day before the index consultation) of the index consultation were linked. Any admission that took place within 32 days of the discharge date of the first admission were linked as well, provided that the admission was by an injury related clinical department (eg Orthopaedics) or had an injury-related diagnosis code or could be a late complication of injury (based on the discharge diagnosis). All procedures, prescriptions and laboratory tests that took place during the inpatient stay were then linked. All consultations up to one year after the index consultation were then processed and linked if they complied with the following rule: If they were on the same date and with an injury-related diagnosis code, or If they were within 122 days of a previously linked consultation and had a late complication diagnosis code, or If they were within 59 days of a previously linked consultation and were at an injury related clinical department, or If they were within 17 days of a previously linked consultation and had a followup diagnosis type, or If they were within 59 days of a previously linked consultation and had the same diagnosis as the index consultation. For each linked consultation all procedures, prescriptions and laboratory tests that took place within three days of the date of the selected consultation (starting on the day before the consultation) were then linked. A second pass was then made through all admissions and all admissions that coincided with any linked consultation were linked as well, provided that they were at a injury related clinical department. All procedures, prescriptions and laboratory tests that took place during the inpatient stay were then linked. The following table (Table 4) summarises the outcome of the linkage process:

8 554 ROAD ACCIDENT FUND COMMISSION REPORT 2002 VOLUME 3 TABLE 4 RECORD LINKAGE OUTCOME Item Total records Total Linked % linked Cases % Consultations % Admissions % Theatre procedures % Imaging procedures % Prescriptions % Laboratory requests % CASE SUMMARY Certain summary information was then calculated per case to ease later processing. In particular whether the case was admitted at any stage and the number of ICU and ward days per case. 11.9% of the sample cases were admitted, with an average length of stay of 0.25 ICU days and 7.74 ward days.

9 HERBST - COST OF CARE 555 TABLE 5 ICD-9 DIAGNOSIS GROUP FREQUENCY ICD 9 Group Frequency Superficial injury, other/unspecified/multiple Sprain lower limb Superficial injury head, face/neck Sprain upper limb 862 Sprain ankle/foot 634 Dislocation 528 Fracture pelvis/lower limb 456 Fracture upper limb 411 Fracture hand 298 Foreign body eye 270 Fracture chest, clavicula/scapula 231 Sprain back 172 Concussion 162 Burn, all other 88 Open wound lower limb 53 Sprain other/ill defined 51 Fracture skull/face, excl nose 48 Sprain wrist/hand 43 Contusions 41 Internal injury 39 Open wound head, face/neck 39 Injury, other and unspecified 33 Nerve damage 27 Open wound finger 23 Burn head, face/neck 22 Fracture/dislocation vertebral column/spinal cord 22 Open wound hand 15 Open wound other/upper arm 13 Head injury, other 12 Open wound arm 10 Amputation finger/toe 7 Amputation arm/leg 3 Blood vessel injury 2 Fracture nose 1 Fracture toe 1 The diagnosis code of the primary diagnosis of the index consultation was assigned to each case. This diagnosis code was then used to determine the diagnostic group of the case. The frequency per diagnostic group is given in Table 5. CALCULATING SERVICE PROFILE PER DIAGNOSIS GROUP For each diagnosis group the following summary information was then calculated: 1) Proportion of cases in group admitted to hospital 2) Average number of consultations per case 3) Average length of stay in general ward 4) Average length of stay in ICU

10 556 ROAD ACCIDENT FUND COMMISSION REPORT 2002 VOLUME 3 5) Proportion of admissions with ICU admission 6) Average number of theatre procedures and anaesthesia per UPFS category per admitted case 7) Proportion of group with imaging procedures per UPFS category 8) Average number of imaging procedures per UPFS category per case with imaging procedures 9) Average medication cost per case 10) Average laboratory cost per case 11) Proportion requiring rehabilitation 12) Average number of rehabilitation consultations per case requiring rehabilitation MODELLING PARAMETERS The modelling parameters used are summarised in Table 6. The starting point of the model is the number of traffic accidents in the period of interest. The current model use the figures published by the Department of Transport for 1998.

11 HERBST - COST OF CARE 557 TABLE 6 MODEL PARAMETERS Parameter Value Result Notes Number of accidents Accidents with fatalities Accidents with serious injury Accidents with slight injury Accidents with property damage only Number of fatally injured individuals per accident Number of seriously injured individuals per accident Number of slightly injured individuals per accident Total injured individuals Proportion of fatalities dying in hospital Injured individuals making use of advanced life support transportation Injured individuals making use of intermediate life support transportation Seriously injured individuals making use of basic life support transportation Slightly injured individuals making use of basic life support transportation Proportion of seriously injured seeking care at public facilities Proportion of slightly injured individuals seeking care at public facilities Total injured individuals seeking care at public facilities Proportion of injured receiving care in a Level 1&2 facility 0.70 Regional and district hospitals Proportion of cases treated by a specialist 0.20 Adjustment to correct for tender price medication costs 2.71 Include distribution and handling costs Advanced life support transportation by public sector Intermediate life support transportation by public sector Basic life support transportation by public sector The total number of injuries calculated is then distributed across the diagnosis categories according to the frequency distribution calculated from the HSRC data (Table 3). CALCULATING PROPORTION OF INJURED INDIVIDUALS SEEKING CARE IN PUBLIC FACILITIES According to the October Household Survey % of South Africans have medical aid coverage. In rural areas this coverage is as low as 5%. However, in spite of this 45% of individuals consulted private health practitioners in the corresponding period. It is clear that individuals is prepared to pay out of pocket for private medical care rather than make use of public care facilities. It is therefore difficult to estimate the proportion of road accident victims that will actually make use of public care facilities. For the purposes of this model

12 558 ROAD ACCIDENT FUND COMMISSION REPORT 2002 VOLUME 3 the estimation is set at 80% for serious injuries and 50% for minor injuries. Due to the lower cost involved it is assumed that a larger proportion of individuals will opt to make use of the private sector for minor injuries. SERVICE COSTS All service costs are based on the 2001 edition of the UPFS. Most UPFS tariffs have two components. A professional component covering the value of service component provided by the health care professional and a facility component representing the cost of providing an environment within which to deliver the care. The professional component varies with the qualification level of the professional (higher for specialists) and the facility component varies with the level of the health care facility (higher for tertiary hospitals) in which the service is rendered. The proportions used in the model are based on statistics obtained from the Gauteng provincial health department. Table 7 summarises the service costs used in the model: TABLE 7 UPFS FEE, 2001 EDITION UPFS Service Basis Prof Fee Prof Fee Facility Fee Facility Fee GP Specialist Level 1&2 Level 3 Anaesthetics Cat A Procedure R 91 R 136 Anaesthetics Cat B Procedure R 153 R 230 Anaesthetics Cat C Procedure R 541 R 812 Medical Report Report R 109 R 163 R 57 R 69 Radiology, Cat A Procedure R 29 R 55 R 28 R 33 Radiology, Cat B Procedure R 84 R 157 R 79 R 94 Radiology, Cat C Procedure R 277 R 761 R 373 R 447 Radiology, Cat D Procedure R 921 R R 950 R Inpatient General ward Day R 66 R 85 R 573 R 688 Inpatient High care 12h R 33 R 42 R 689 R 827 Inpatient Intensive care 12h R 33 R 42 R R Inpatient Chronic care Day R 66 R 85 R 464 R 557 Day patient Day R 66 R 85 R 278 R 334 Prescription fee Prescription R 15 R 18 Outpatient Consultation Visit R 66 R 85 R 29 R 35 Emergency Consultation Visit R 117 R 176 R 61 R 73 Ambulatory Procedure Cat A Procedure R 115 R 115 R 176 R 211 Ambulatory Procedure Cat B Procedure R 296 R 402 R 176 R 211 Ambulatory Procedure Cat C Procedure R 562 R 843 R 176 R 211 Ambulatory Procedure Cat D Procedure R R R 176 R 211 Theatre Procedure Cat A Procedure R 115 R 115 R 808 R 969 Theatre Procedure Cat B Procedure R 296 R 402 R R Theatre Procedure Cat C Procedure R 562 R 843 R R Theatre Procedure Cat D Procedure R R R R Suppl Health Treatment - Allied Contact R 43 R 23 R 28 Patient transport service 100km R 159 Basic life support 50km R 257 Intermediate life support 50km R 318 Advanced life support 50km R 408 Emergency service standby Hour R 186 R 279 R 46

13 HERBST - COST OF CARE 559 The SAMHS data contains only the cost price of the medication used. A correction factor was calculated from the price list for pharmaceuticals in public facilities recently developed by the Department of Health. The provided laboratory costs were also adjusted to be in line with the recommended BHF tariffs. RESULTS Table 8 summarises the total cost and cost per case by diagnosis group. TABLE 8 COST PER DIAGNOSIS GROUP Diagnosis Group Cases Total Cost Cost per Case Fracture pelvis/lower limb Fracture/dislocation vertebral column/spinal cord Sprain back Contusions Internal injury Fracture upper limb Fracture skull/face, excl nose Superficial injury, other/ unspecified/multiple Head injury, other Concussion Superficial injury head, face/neck Fracture chest, clavicula/scapula Advanced life support transport Intermediate life support transport Open wound lower limb Injury, other and unspecified Sprain lower limb Amputation arm/leg Basic life support transport Sprain ankle/foot Dislocation Open wound head, face/neck Sprain upper limb Open wound other/upper arm Fracture hand Nerve damage Burn, all other Sprain other/ill defined Sprain wrist/hand Amputation finger/toe Open wound finger Open wound arm Foreign body eye Open wound hand Burn head, face/neck TOTAL

14 560 ROAD ACCIDENT FUND COMMISSION REPORT 2002 VOLUME 3 The total cost per annum using the parameters listed in Table 6 is approximately R320 million. The biggest contribution is from fractures of the pelvis and lower limb at R127 million, more than three times the amount of the next highest group consisting of spinal injuries. The most expensive group per case is spinal injuries at R per case. It should be kept in mind that the costs represented here only contain cost within the first year of treatment and long-term spinal cases will obviously cost much more. TABLE 9 BREAKDOWN OF COSTS PER SERVICE Service Cost % Emergency consultations % Routine consultations % General ward days % ICU Days % Theatre procedures % Imaging procedures % Medication % Laboratory costs % Rehabilitation treatment % Emergency transport % TOTAL The biggest proportion of the costs goes towards hospital accommodation, followed by medication. TABLE 10 SUMMARY SERVICE INDICATORS Indicator n % Cases Cases admitted % Cases admitted in ICU % Total admissions Total patient days Average length of stay 8.03 Average inpatient days per case Total consultations Average consultations per case 2.58 Total theatre procedures Average theatre procedures per admitted case 0.30 Total imaging procedures Average imaging procedures per case 1.50 Average medication expenditure per case 264 Average lab costs per case 261

15 HERBST - COST OF CARE 561 COMPARABILITY OF SAMHS DATASET WITH THE HSRC INJURY SAMPLE Age and gender comparison Figure 1 compares the age breakdown of the military cases with those of the HSRC sample. The military data set has a significantly higher proportion of individuals in the age group at the expense of individuals in the older age groups. However, the military sample contains cases across the complete spectrum of age groups. Twenty-four percent (24%) of cases in the military sample are female, compared to 41% in the HSRC sample. FIGURE 1 AGE DISTRIBUTION OF MILITARY INJURY CASES COMPARED TO HSRC INJURY SAMPLE Age Distribution 40.0% 35.0% 30.0% Military HSRC 25.0% % 20.0% 15.0% 10.0% 5.0% 0.0% < Age Group SERVICE PROFILE Item HSRC Military % of cases admitted to hospital 43% 30% % of cases admitted to ICU 1.5% 4% A larger proportion of HSRC cases are admitted compared to military dataset, this could be due to the more serious nature of traffic accidents compared to all cause injuries. The length of stay data from the HSRC data set is impossible to interpret due to extensive date transcription errors. The average length of stay in the military dataset (10.66 days) compares well with length of stay in the United States dataset 4 of 10 days.

16 562 ROAD ACCIDENT FUND COMMISSION REPORT 2002 VOLUME 3 SENSITIVITY ANALYSIS This section explores the sensitivity of the model to changes in the input parameters. The impact of a change in one parameter while the others are kept constant on the total cost of treatment will be graphically shown. Number and severity of injured persons as a percentage of total accidents FIGURE 2 IMPACT OF CHANGE IN INJURY PERCENTAGES ON TOTAL COST 390 Changes in Injury Percentages 370 Total cost (millions) "5% Major Injuries" "6% Major Injuries" "7% Major Injuries" "8% Major Injuries" "9% Major Injuries" % 15% 16% 17% 18% Minor Injuries This parameter reflects the overall injury incidence per year and shows how total costs will rise with an increase in injury incidence. A 1% change in minor injury incidence result in a R11 million change in costs and a 1% change in major injury incidence in a approximate R20 million change. PROPORTION OF FATALLY INJURED PERSONS DYING IN HOSPITAL In the accident statistics fatalities include those that die within 7 days after the accident. No data is available on the proportion of fatalities dying in hospital. The sensitivity analysis shows that the costs will increase by approximately R2 million for each 5% increase in the proportion.

17 HERBST - COST OF CARE 563 FIGURE 3 CHANGES IN PROPORTION OF FATALLY INJURED PERSONS DYING IN HOSPITAL Changes in Proportion of Fatalities Dying in Hospital Cost (millions) % 5% 10% 15% 20% 25% 30% % dying in Hospital CHANGES IN PROPORTION OF INJURED PERSONS MAKING USE OF PUBLIC FACILITIES As discussed before the actual proportion of traffic accident victims making use of public facilities is difficult to predict. Empirical information is difficult to come by. Although the October Household Census reports only 16% of individuals with medical aid coverage, 45% of all individuals made use of private health care facilities at some point. For this reason a wide range of potential usage patterns were explored. The proportion of those with serious injuries using health care facilities was varied between 75% and 85% in 1% increments. The proportion of minor injuries was varied in 5% increments between 45% and 85%. A 1% increase in major injuries resulted in a R1.6million increase and a 5% increase in minor injuries in a R16million increase in total cost of care. The minimum amount at 75% major and 45% minor injury proportion was R294 million and the maximum at 85% major and 85% minor injuries was R456 million. The model only uses the differences in the serious and minor injuries indirectly to calculate total injuries. Actual case resource use depends entirely on the diagnostic group of the injury.

18 564 ROAD ACCIDENT FUND COMMISSION REPORT 2002 VOLUME 3 FIGURE 4 CHANGES IN USAGE OF PUBLIC SECTOR FACILITIES Major and Minor Injury Public Sector Use Cost (Rmillion) Minor Injury Usage 45% 50% 55% 60% 65% 70% 75% 80% 85% % 76% 77% 78% 79% 80% 81% 82% 83% 84% 85% Major Injury Usage Changes in proportion of victims receiving care at level 1 public facilities FIGURE 5 CHANGES IN PROPORTION OF CARE IN LEVEL 1 FACILITIES Change in Level 1 Care Proportion Cost (million) % 65% 70% 75% 80% 85% Level 1 Care Proportion

19 HERBST - COST OF CARE 565 A certain proportion of individuals will receive care in level1 facilities rather than in tertiary facilities. A 2.5% change in this parameter will cause an approximate change of R1 million in the total cost of care. Changes in the proportion of victims receiving specialist care Some victims will receive care from specialist health care providers, who in terms of the UPFS charge more for their services. A 2.5% change in this parameter translates into an approximate R change in total costs. FIGURE 6 CHANGE IN SPECIALIST CARE PROPORTION Change in Specialist Care Proportion Cost (million) % 10% 15% 20% 25% 30% Specialist Care Proportion COST PER PATIENT DAY EQUIVALENT As a verification of the model the average cost per patient day equivalent was calculated for the total cases. Patient day equivalents (PDEs) are commonly used to compare costs across hospitals. PDEs are calculated by adding the total number of inpatient days to one third of the outpatient consultations during the period of interest. The average cost per PDE for the modelled cases is R This is somewhat higher than the average cost per PDE for all cases in public hospitals (for example in the Northern Province this ranges from R463 for level 1 hospitals to R547 for level 2 hospitals and R737 for level 3 hospitals). The higher figure found for injury cases reflects the higher cost of care for these cases.

20 566 ROAD ACCIDENT FUND COMMISSION REPORT 2002 VOLUME 3 COST OF CARE IN PRIVATE FACILITIES As a comparison the equivalent total cost of care in private facilities was calculated using the information contained in trafic report. They classify injured cases as follows: P1 (red code): Very serious injuries, admitted to ICU, patient is unable to communicate. 6,8% of private patients are P1 s. P2 (yellow code): Patient sustained serious enough injuries to be admitted to a general ward, however, patient is able to communicate. 41,4% of private patients are P2 s. P3 (green code): These patients are treated at the hospital casualty department directly after the accident but are not admitted as in-patients. 50% of private patients are P3 s. P4 (blue code): These patients passed away in the MVA, on the way to the hospital or on admission. 0,7% of private patients are P4 s. TABLE 11 COST OF VEHICLE ACCIDENT INJURY CARE IN THE PRIVATE HEALTH CARE SECTOR Classification Hospital Account Doctors Account of Patient Value Value Total P1 R R R P2 R R R P3 R R R P4 R R R Source: trafic report From the report the ratio between P1 to P4 patients can be calculated and applied to the total calculated injury cases. Table 11 summarises the total cost of care using these figures: TABLE 12 TOTAL COST OF CARE IN PRIVATE HEALTH CARE FACILITIES Classification Proportion Number of Cost/Case Total of cases cases P1 6.8% R P2 41.4% R P3 50% R Total R

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