A cost analysis of road traffic injuries in a tertiary hospital in south-west Nigeria

Abstract

This study examines the burden of road traffic injuries (RTIs) among road crash victims in a tertiary hospital in Ibadan, Nigeria. The study adopted a purposive sampling method to obtain primary data. Interview was done with 266 RTI victims who were admitted to the University College Hospital, Ibadan and discharged between March and May, 2015, using a structured questionnaire. From the data obtained, the study carried out descriptive statistical analyses. The results showed that the average cost per patient for RTI treatment was ₦ 42,946 ($215.9); on average, the amount expended on surgery was the highest followed by wound dressing and drugs; and the prevalence of catastrophic out-of-pocket (OOP) expenditure was over 86%. It is recommended that given the high burden of OOP hospital expenditure associated with RTI, there is need to implement more effective financial protection mechanisms against the high OOP expenditure faced by crash victims.

Keywords:

• road traffic injury
• hospital cost
• out-of-pocket expenditure
• catastrophic expenditure
• Nigeria

Acknowledgments

The authors thank the anonymous reviewer for the comments and suggestions which have help to improve the content of this work.

Disclosure statement

The authors declare that they have no competing interests.

Notes

1. The Federal Road Safety Corps is a government agency saddled with the responsibility of ensuring safety on the roads.

2. For the purpose of this study, a road crash is defined as one which took place on the road that involved at least one moving vehicle, including two-wheeled (motorcycle) and three-wheeled.

3. RTI victims admitted to intensive care or emergency unit are usually required to pay the bills incurred at these sections before being transferred to the ward for further care. These expenditures were also included in the ‘other miscellaneous cost’ category.

4. The nurses on duty in the RTI wards helped in identifying patients who were due for discharge from the hospital so that they may be interviewed.

5. Yoruba is the local language in the study area.

6. –Bed Space = daily bed × duration of in-patient stay (in days).

–Feeding cost was calculated based on the duration of in-patient stay. One square meal a day at the health facility was purchased at ₦600 (= 3.02US$, using the average exchange rate of US$1 = ₦198.9 for the period the survey was conducted). We added this to the amount spent on beverages to help respondents estimate their cost of feeding.

–In cases where a patient had also sought any form of medical care for the RTI before assessing treatment in the study site, out of pocket expenses for the treatment was recorded as pre-consultation.

7. For those without source of income (especially persons below 18 years), the monthly household income of the person responsible for their medical expenses was used as a proxy for calculating the annual household income.

8. ‘Whiplash’ is a classic example. Despite the fact that it has a value of Abbreviated Injury Scale (AIS) of ‘1’ (slight) and does not always require hospitalization, it is one of the most expensive injuries for some European Union insurance companies (European Transport Safety Council [ETSC], 2007). The same thing happens with psychosocial conditions such as post-traumatic stress disorder, which has been considered very frequent, with prevalence ranging from 18% to 25% in three – six months after an accident (European Transport Safety Council, 2007).