Estimating the financial implications of pressure ulcers in private hospitals in South Africa

• Main Author: Carvounes, Angeliki
• Other Authors: Ranchod, Shivani
• Format: Dissertation
• Language: English
• Published: Faculty of Commerce 2020
• Subjects: Commerce
• Online Access: https://hdl.handle.net/11427/31690

Quality of care is a concept used to assess the value of healthcare services. Measures of quality of care are important in South Africa given the lack of information on the quality of services delivered in the healthcare sector. Pressure ulcers are an example of an adverse outcome of a hospital case and indicate poor quality of care. The financial implications of this event therefore represent an estimate of the cost of poor quality of care. The objective of this research is to estimate the financial implications of pressure ulcers in private hospitals in South Africa on a risk-adjusted basis. Pressure ulcers are identified using administrative data from medical schemes. Statistical modelling and statistical tests are used to create risk cells so that comparisons are done on a like-for-like basis. The results indicate that the average financial implications for a hospital case where an individual is diagnosed with a pressure ulcer, on a risk-adjusted and weighted basis, is 3.3 times the average financial implications for a hospital case where an individual is not diagnosed with a pressure ulcer. The impact of this event on the medical scheme industry is estimated at R1.4 billion. Identifying hospital cases where an individual is diagnosed with a pressure ulcer is limited because the data are used for reimbursement and case management. The financial implications could have been affected by additional factors not available in the data. Pressure ulcers result in non-financial implications for the individuals receiving and delivering healthcare services. These are not quantified in this research. Pressure ulcers are only one measure amongst many metrics that can be used to assess quality of care. Private hospitals can use a measure of pressure ulcers to quantify the quality of their healthcare services. Managed care organisations can therefore use these results to create a network of hospitals and they can use these results when negotiating with hospitals on the amount that they will reimburse them for the services that they provide.