Cost of inpatient care for HIVpositive patients at Red Cross Children\'s Hospital, Cape Town

Abstract

There is anecdotal evidence that certain categories of patients at Red Cross War Memorial Children\'s Hospital (RCH) are thought to be utilising more resources than others. Faced with an ever-increasing demand for care, shrinking budgets and tough measures by government to force health managers to operate within budget, bold decisions need to be taken regarding future admission policy. The aim of this retrospective record-based study was to assess the cost of inpatient care for paediatric HIV-positive patients at RCH over a 1-year period (January - December 2001). The objectives were (i) to determine the cost of inpatient care for paediatric HIV-positive patients; and (ii) to provide baseline data for health managers to develop future admission policy and to plan for future needs in terms of management and budgetary protocols.
Methods. The study population consisted of HIV-positive inpatients admitted to RCH. Information on patients\' demographic details, date and duration of admission, reason for admission, additional diagnosis, nutritional status, laboratory investigations done, surgical procedures performed and medication prescribed were obtained from the patient records. Direct costs were recorded for admissions (bed costs), X-rays, laboratory and surgical procedures. The tariff fees charged for these services were obtained in consultation with management at RCH.
Results. There were 16 032 admissions to RCH in 2001. Of these patients 616 (4%) were HIV+. A 25% random sample (N = 154) with a mean age of 1.75 years was analysed. Almost 80% were admitted with diarrhoea and vomiting and/or chest problems. The mean number of previous admissions was 2.0. The most common conditions diagnosed clinically were failure to thrive (64%), pneumonia (54%), gastroenteritis (43%), oral thrush (42%) and tuberculosis (22%). Over half were found to be underweight for their age, 20% were marasmic and 87% suffered some form of malnutrition at admission. HIV+ patients were 4.7 times more likely to die in hospital than HIV-ve patients. Their average length of stay in hospital was 9 days, compared with 4 days for HIV-ve patients. HIV+ patients consumed 12%, 61% and 9% of the total budgets allocated for antibiotics, antifungals and analgesics, respectively (7% of the total budget for medicines). The average cost (direct cost) for each HIV+ inpatient amounted to R18 765.76. Admission (bed) costs formed the bulk of this amount (84%) followed by laboratory costs (9%), medication (3%), surgical (2%) and X-rays (2%). Alarmingly, HIV+ patients, who formed 4% of the total admissions, consumed 26% (R11.56 million) of the total budget for direct treatment costs (R44.65 million).
Conclusion. The current admission policies regarding HIV+ patients to RCH appear unsustainable, given the continued high demand for care, an ever-increasing HIV pandemic, the non-availability of antiretroviral therapy, lower health budgets and the continued inability of these patients to pay for health services.
Southern African Journal of HIV Medicine Vol.5 (4) 2004: 32-40

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