Cost analysis of violence-related medical imaging in a Free State Tertiary Trauma Unit

Abstract

Background: Violence is a leading public health problem worldwide. Beyond the pain and suffering, violence has a significant economic impact on a country’s health, policing, and judicial services. Due to the lack of current and comprehensive data in South Africa, local violence-related economic impact studies are largely estimations. Violence-related imaging expenditure, as a component of a public hospital’s expenditure, is yet to be determined. Objectives: To measure the violence-related patient burden on Pelonomi Tertiary Hospital’s (PTH) trauma and radiology services, determine the imaging-component cost of violence-related injuries and calculate the financial burden violence has on the hospital’s expenditures. Method: From the PTH’s Trauma Unit patient registry, 1 380 patients with violence-related injuries were consecutively sampled for six months ending 31 December 2017. Imaging investigations were documented and categorised according to the South African National Department of Health’s (SANDOH) 2017 Uniform Patient Fee Schedule (UPFS). Descriptive analysis and cost calculations were performed using the 2017 UPFS tariff schedule and hospital-specific health efficiency indicators i.e. Patient Day Equivalent (PDE) and Expenditure per Patient Day Equivalent (ExPDE). Results: Violence-related injuries accounted for 50.64% of all trauma department visits and received a total of 5 475 imaging investigations. Violence-related imaging investigations represented 14.81% of all investigations performed by the radiology department in the study period. Overall violence-related admission costs amounted to R35 410 241.85 (8.33% of the hospital’s total expenditure) of which 20.08% (R7 108 845.00) was attributed to imaging investigations. Conclusion: Violence-related admissions had a high patient and financial burden on PTH. The pinnacle of health care cost saving is violence prevention; however, the cost-conscious radiologist could assist with cost saving if responsible and ethical imaging practices are followed.