The cost of home-based terminal care for people with AIDS in South Africa
AbstractObjectives. To describe the costs of establishing and operating a home-based care (HBC) project providing palliative care for people with AIDS CPWA), and to project the full costs to the health care system of extending this care model.
Design. Data were collected from seven sites participating in the Hospice Association of South Africa integrated community home-based care (ICHC) model, using site records, interviews with personnel, a continuity of care survey of nursing staff supervising the sites, and time logs kept by community caregivers (CCGs). The seven sites were spread across five provinces, with a mix of rural, peri-urban and urban settings.
Outcome measures. Set-up (training, equipping and planning) costs per HBC site, HBC operating costs (total and average cost per patient), and average hospital inpatient, hospital outpatient and primary care clinic cost per participating patient. Estimates of scaling up this model of HBC to national roll-out are also provided.
Results and conclusions. Providing palliative HBC to PWAs in their last year of life using the ICHC model costs R2 840 per patient per year. Even with this level of HBC input, patients still incurred hospital costs of R2 522 and primary care clinic costs of R1 154 per patient per year. HBC costs are increased in rural areas where a vehicle is required for staff transport. HBC shows considerable potential to deal cost-effectively with growing palliative care needs in the face of the AIDS epidemic, but we need to understand better the true extent to which HBC can substitute for hospitalisation.
Copyright remains in the Author’s name. The work is licensed under a Creative Commons Attribution - Noncommercial Works License. Authors are required to complete and sign an Author Agreement form that outlines Author and Publisher rights and terms of publication. The Agreement form should be uploaded along with other submissions files and any submission will be considered incomplete without it [forthcoming].
Material submitted for publication in the SAMJ is accepted provided it has not been published or submitted for publication elsewhere. Please inform the editorial team if the main findings of your paper have been presented at a conference and published in abstract form, to avoid copyright infringement. The SAMJ does not hold itself responsible for statements made by the authors.
Previously published images
If an image/figure has been previously published, permission to reproduce or alter it must be obtained by the authors from the original publisher and the figure legend must give full credit to the original source. This credit should be accompanied by a letter indicating that permission to reproduce the image has been granted to the author/s. This letter should be uploaded as a supplementary file during submission.