Research and Theory Towards a National Injury Costing System?:Lessons from a Public-Private Injury Costing Pilot Study in South Africa

Abstract

South Africa has extremely high incidence rates of fatal and non-fatal injuries due to interpersonal violence, pedestrian–motor vehicle collisions, burns, falls and other unintentional causes. While the actual cost associated with these injuries remains relatively unknown, the estimated direct cost of the medical treatment, rehabilitation and administration of these victims may run into billions of rands. This public–private injury costing pilot study (hereafter the study) was conducted at a tertiary public health facility in Johannesburg, South Africa (hereafter the public facility). The study attempted to facilitate further costing capacity through skills transfers from personnel at a sentinel private health facility in Johannesburg (hereafter the private hospital) to selected personnel within the identified public facility, and through the determination of the partial baseline direct medical cost of the treatment of gun shot wounds, pedestrian–motor vehicle collision injuries, falls and burns at the public facility. Both the capacity building component and the actual study were complicated by a number of obstacles, including limited personnel, poor costing and billing capacity, underdeveloped billing documentation and recording procedures, and limited levels of investment in the general practice of injury costing in the public health sector itself. This article examines the practical challenges facing further attempts to describe the cost of injuries in South Africa. It concludes with several critical reflections on concerns associated with an uncritical pursuit of the roll-out of a national injury costing system, which may have a negative impact on service delivery to the very populations that encounter injuries as a public health sector priority.