Costing injuries in South Africa: preliminary results and challenges from a pilot study

Abstract

South Africa has extremely high incidence rates of fatal and non-fatal injuries due to interpersonal violence, motor vehicle crashes (many involving pedestrians), burns, falls and other unintentional injuries. The direct costs associated with the medical treatment, rehabilitation and administration of these victims run into billions of Rands which could be more productively spent on primary prevention to reduce the number of new cases and improve overall life quality. Yet, the costs of injuries in the South African public health sector remain relatively unknown. To provide baseline direct medical costs for the treatment of gun shot wounds (GSWs), pedestrian-motor vehicle collision injuries (PMVCIs), falls and burns at a tertiary public health facility in Johannesburg, South Africa using adapted private health care costing procedures. Fifty-five patients were enrolled in the study, 48 of which were included in the final cost calculations. Gun Shot Wounds (GSWs) accounted for the majority (38.2%) of the injury types costed. On average, this type of injury was the most expensive to treat at ZAR6395.65 per case costed. The average treatment of PMVICs was calculated and ZAR3885.97 and the average direct cost of treating a fall was ZAR2747.83. The pilot study was complicated by the general absence of a culture of costing and a lack of general investment in the practice of injury costing itself. Further attempts to describe the costs of injuries in South Africa must address these challenges in the formative planning stages of the research. Nevertheless, despite these limitations, aggregate direct medical costs of treating these injuries reveal an immense financial burden on the public health system if extrapolated to the total incidence of injuries in South Africa. Furthermore, they support the argument for the re-direction of financial resources to primary prevention initiatives to reduce the number of new cases, improve overall life quality of populations, and minimise fiscal pressures on an already over-burdened health system in South Africa.