PROVIDER CREATED DEMAND AND COST OF TREATING NON-FATAL ROAD TRAFFIC INJURIES IN KERALA, INDIADr. Godwin SK 1 1 Associate Professor, Department of Economics, Government College for Women, Thiruvananthapuram- 695 014, Kerala, India |
|
||
|
|||
Received 17 November 2021 Accepted 25 December 2021 Published 31 January 2022 Corresponding Author Dr.
Godwin SK, godwinsk@yahoo.com DOI 10.29121/granthaalayah.v10.i1.2022.4479 Funding:
This
research received no specific grant from any funding agency in the public,
commercial, or not-for-profit sectors. Copyright:
© 2022
The Author(s). This is an open access article distributed under the terms of
the Creative Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original author and source are
credited. |
ABSTRACT |
|
|
Context:
Provider-created demand has been found to be a component of out-of-pocket
payments and consequent financial burden. Road traffic injuries are a classic
case of medical uncertainty where treatment interventions could be induced
especially when the provider’s income is dependent on the quantity of care
provided. The debate on the existence and form of SID continues unabated for
the last three decades with no clear signs of a consensus. The paper argues
that under conditions of uncertainty and imperfect competition in health care
market, SID is quite likely and it is possible to detect. Methods: Three
hundred non-fatal road traffic injury cases from seventeen hospitals (from
public sector, private for-profit and not-for-profit sectors) were selected
from three districts in Kerala, India. Besides, via case-study method
appropriateness of treatment prescribed by the provider and utilized by the
patient is evaluated. Using them, under-consumption or under-prescription of
treatment or over treatment also assessed. Results
& Discussion: Firstly, higher level of
service intensity was found in private sector compared to the public sector,
even when the length of treatment for inpatients is higher in public
hospitals. More than 76 percent of the patients who received less than 10
doses of medicines are in the public sector and 17 percent in private sector.
Secondly, service intensity based on physician recommendation and use of scan
across public and private providers finds that 52 percent of the entire scans
were recommended by public sector. While 29 percent scans were prescribed by
private health services and 19 percent by public and private sectors
together. Thirdly, using a checklist and observation form, after controlling
for co-morbidity and hospitals with similar facility with public and private
ownership, two cases with clinically similar injury conditions were selected.
While private health facilities were over- treating patients, public
hospitals under-treat patients. |
|
||
Keywords: Financial
Burden, Road Traffic Injuries, Kerela 1. INTRODUCTION Health care market displays some interesting but
complex relationship between the care seeker and care giver. Due to the
existence of asymmetry of information of differing degree, agency is both a
solution and problem in cost-effective utilization of health care. A solution
because in the absence of agent, the principal (the care seeker) would have
to spend a greater degree of time and energy to accumulate the knowledge for
treating an ailment which is a remotely effective. A problem because
imperfect principal – agent relationship directs the agent to work against
the interest of principal, thereby increasing the cost and worsen quality of
care. The second problem is generally described as supplier induced demand (SID) in health
economics literature. Uncertainty in the outcome |
|
||
of health care interventions adds to the problem of costs
and expenditure. Thus, more than the required care has implications for cost,
access and burden.
In the context of inform
Conceptual
framework: We argue that the financial burden of tre
One of
the assumptions is th
Injury care expenditure or the financial burden
of the household of an injured can be captured using the following model:
FBT = f (pb, bp, a, g, y, cm, ls, p-a, ts, hp, ib, ins)
Where,
FBT Financial
Burden or the total cost of the treatment
pb Severity
of the injury (physical burden)
Bp Body
part affected
a Age
s Gender
y Household
income
cm Co-morbidity
ls Length
of stay
p-a proposed
minus actual tre
ts Time
space between proposed & actual tre
hp Health
care provider
ib Institutional
behaviour
ins Insurance
Various components of the total cost of injury
care to the injured can be explained using the following expression
C = MC +
OC(I) +OC (H) + ML + T + INT + M
Where,
C Cost
of tre
MC Medical
Cost
OC(I) Opportunity
cost of the injured
OC(H) Opportunity
cost of the household
ML Medico-legal
expenses
T Cost
of transport of the p
F Cost
of food of the p
INT Interest
and other costs of financing
M Miscellaneous
(Vehicle damage, compens
Medical cost can be further decomposed using the
following equ
MC = f
(c, sg, ph, dg, eq, sp)
Where,
MC Medical
cost of tre
c Consult
sg Surgery
ph Medicines
dg Diagnostics
eq Equipment
sp Supplies
2. METHODOLOGY
Three
hundred and two non-fatal road traffic injury cases from seventeen hospitals
(from public sector, private for-profit and not-for-profit sectors) were
selected from three districts in Kerala, India. Besides, via case-study method
appropriateness of tre
The appropri
3. RESULTS
3.1. SERVICE INTENSITY ACROSS PROVIDERS
Service intensity across different providers figure out
that private sector has a higher level of service intensity when compared to
the priv
Table 1 Proportion of Medicine Prescription Across Providers |
||||
Medicines (Quantity) |
Public |
Private |
Public & Private |
Total |
< 10 |
67 (76.1) |
15 (17.0) |
6 (6.8) |
88 (33.8) |
10-25 |
15 (45.5) |
15 (45.5) |
3 (9.1) |
33 (12.7) |
26-50 |
22 (40.0) |
15 (27.3) |
18 (32.7) |
55 (21.2) |
51-100 |
8 (19.5) |
10 (24.4) |
23 (56.1) |
41 (15.8) |
> 100 |
22 (51.2) |
12 (27.9) |
9 (20.9) |
43 (16.5) |
Total |
134 (51.5) |
67 (25.8) |
62 (22.7) |
260 (100.0) |
Analysis of service intensity based on the recommend
Table 2 Proportion of Scan Prescription Across Providers |
||||
Number of the injured |
||||
Scan (Number) |
Public |
Private |
Public & Private |
Total |
1 |
54 (49.1) |
21 (19.1) |
15 (13.6) |
90 (81.8) |
2 |
3 (5.3) |
11 (10.0) |
6 (5.5) |
20 (18.2) |
Total |
57 (51.8) |
32 (29.1) |
21 (19.1) |
110 (100.0) |
Participant
observation - a case study
This is
the result of the analysis undertaken using a protocol with the help of the
tool – “Participant Observation Form”. One patient each with head injury
(forehead) was taken to a hospital A (a private hospital) and (hospital B) a
public hospital respectively. Both the
hospitals are referral centres and as such provide advanced care. One hospital
with a bed occupancy rate of more than 170 per cent and another with a bed
utilization rate close to fifty per cent.
Clinical
condition of both the patients are:
Blood
pressure: Normal
Pulse
rate. Normal
Loss of
consciousness: No
Physical
examination: Wound on the skull and no other external injury
History
of vomiting: No
ENT
Blooding: Nil
Glasgow
Coma Scale (GCS): 15/15
Interventions
In
hospital A, the injured was admitted for two days and was advised a CT scan and
medicines and wound debridement.
In
hospital B, the patient was advised observation for a period of five hours and
advised routine medicines. Wound debridement was undertaken and a CT was advised,
only if GCS worsens, which has not happened either.
Clinical
assessment
Hospital
A advised a CT scan to the patient without any medically justified reason,
because objectives conditions like no history of vomiting, no ENT blooding,
adequate GCS were found. There is also no apparent reason for admission and the
patient could have been treated as out-patient with some extended hours of
observation.
Hospital
B has gone almost close to the criteria of medically justified interventions.
However, there was a delay in getting treatment at fast speed, and the crowded
state of the observation room probably led the physician to prescribe five
hours of observation which could be extended for about 10 hours.
Incentives faced by the provider constitute the
gold-mark for distinguishing between inefficiency
4. DISCUSSION
Over-prescription
is one of the prime reasons for injured downgrading the ranking of priv
The phenomenon th
The
present study found th
5. SUMMARY
In health care markets where the providers are reimbursed on the basis of quantity of interventions prescribed and utilised, providers have a tough incentive to induce more interventions than are medically justified. Thus, SID has implications for cost, access and burden. The study finds the existence of SID though does not exactly quantify the actual volume of financial burden imposed by SID. The medical care market in the State has grown without proper policy governing its location, quality of services, price, functioning requirements, access to the unreached etc. A detailed analysis of the medical sub-markets is essential to understand the pricing behaviour in the market.
REFERENCES
Liu X & Mills A (1999) Evaluating payment mechanisms: how can we measure unnecessary care? Health Policy and Planning ; 14 (4) :409-13. Retrieved from https://doi.org/10.1093/heapol/14.4.409
Meng QY, Liu X & Shi Junshi (2000) Comparing the services and quality of private and public clinics in rural China. Health Policy and Planning 15 (4) : 349-356. Retrieved from https://doi.org/10.1093/heapol/15.4.349
Mooney GH (1994) Key issues in Health Economics, Hemel Hempstead: Harvester Wheatsheaf.
Muraleedharan, VR (1999) Characteristics and structure of the private hospital sector in urban India : a study of Madras city. Small Applied Research Paper No. 5, Partnership for Health Reform Project, Abt. Associates, Bethesda, USA.
Newhouse JP (1982). Is competition the answer? Journal of Health Economics 1 : 109-116. Retrieved from https://doi.org/10.1016/0167-6296(82)90023-6
Reinhardt (1985). "The theory of Physician-Induced Demand: Reflections after a decade." Journal of Health Economics 4 (Summer) :187-93. Retrieved from https://doi.org/10.1016/0167-6296(85)90008-6
Roemer, MI (1961) Bed supply and hospital utilization: à natural experiment. Hospitals 1 November : 35 - 42
This work is licensed under a: Creative Commons Attribution 4.0 International License
© Granthaalayah 2014-2022. All Rights Reserved.