Just how expensive is intensive care? Now we know

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Just how expensive is intensive care? Now we know

The figure is a crucial precursor to implementing the National Health Insurance, say medics who crunched the numbers

Cape Town bureau chief


The cost of public hospital intensive care has been tallied for the first time, and it is R22,870 a day.
The amount applies to only one institution – the 846-bed Inkosi Albert Luthuli Central Hospital in Durban – and is based on the 2015/16 financial year.
The University of KwaZulu-Natal medics who came up with the number said the introduction of National Health Insurance meant it was vital information.
“Hospitals will be expected to be competitive and efficient while recovering their costs through the insurance system,” said lead author Saajida Mahomed, reporting her findings in the January edition of the SA Medical Journal.
“Costing of individual patient services ... is therefore an important precursor to the implementation of NHI.”
Mahomed, from UKZN’s School of Laboratory Medicine and Medical Sciences, said intensive care was one of the biggest cost drivers in hospitals, and at Albert Luthuli Hospital she found staffing costs made up 55% of the total.
She analysed 544 admissions to two ICUs: trauma (10 beds) and a combined neurosurgery, medicine and surgery unit (18 beds). Together, they accounted for 4,987 patient days costing R114m.
“The mean cost per admission was R157,883 in the trauma ICU and R245,087 in the combined ICU,” said Mahomed.
“Our cost per patient day was higher than that reported in other low-income countries, but lower than that in high-income countries. “These costs vary owing to the different types of ICUs, wide spectrum of disease prevention and availability of diagnostic and treatment options.”
If she had included Albert Luthuli Hospital’s specialised and paediatric ICUs, average costs would have been higher, said Mahomed.
And because it was the only quaternary hospital in KZN, its patients were likely to have more complex and expensive conditions than those in tertiary or regional hospitals.
One of the ways ICU costs could be reduced, said Mahomed, was to transfer patients out of intensive care as soon as possible. “The [Albert Luthuli] trauma ICU, in particular, is faced with patients awaiting transfer to the referring hospital, as there are no step-down trauma beds.”
The hospital’s cost per patient day of R13,433 (excluding the costs of doctors, nurses, consumables and medicines) was similar to the ICU tariffs charged by private hospital groups MediClinic (R14,006) and Netcare (12,943), said Mahomed.
However, this comparison must be viewed with caution. “In the private sector patients are billed separately for all investigations, pharmaceuticals and consumables used during their ICU stay, and for clinician consultations. “It is therefore likely that the cost per admission in the private sector would be higher than in the public sector.”

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