Nethathe G D, Tshukutsoane S, Denny K J
Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane; and Faculty of Medicine, University of Queensland, Brisbane, Australia; Division of Critical Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2017 Oct 31;107(11):1010-1014. doi: 10.7196/SAMJ.2017.v107i11.12513.
Financial cost is a recognised cause of lack of access to adequate healthcare in South Africa (SA). Data describing the SA healthcare professional (HCP)'s awareness of costs are scant. Their increased awareness of healthcare costs may improve efficacy and reduce wasteful expenditure.
To assess SA HCP's knowledge of healthcare costs, identify factors that influence cost awareness, and to determine if surveyed HCPs received training related to cost management during their studies or at any stage during their practice.
This cross-sectional survey was conducted by means of a standardised questionnaire. HCPs working at a major tertiary academic hospital were asked to answer an anonymous standardised questionnaire aimed at determining their awareness of the costs of commonly requested hospital items and tests. Cost accuracy was determined by assessing the log deviation of the estimated cost from true cost, with values >0 and <0 representing overestimates and underestimates, respectively. Cost estimations were considered correct if the absolute value of the log deviation was <0.2. Participants' attitudes towards the potential impact of the availability of cost information on their practice were assessed.
The overall cost estimation of accuracy was low (mean 0.60; standard deviation 1.99) and differed widely between items. Cheaper items were more likely to be overestimated and expensive items to be underestimated. The majority of participants indicated that cost awareness education was not part of their training or practice (84.5%) and that they would like cost information to be made readily available (92.2%). Eighty-four percent of participants were of the opinion that cost information would not negatively affect patient care.
The use of percentage deviation from true cost as a method of assessing cost awareness creates a bias towards overestimation, which is more relevant for cheap items, as larger overestimates are more common for these items. We propose the use of log deviation of the estimated cost from the true cost as a method of assessing cost estimation accuracy. HCPs have a limited understanding of the costs of disposables, tests and drugs commonly used in their practice and would prefer that cost information be made readily available to them. Attention should be paid to improving cost awareness among HCPs working at SA hospitals.
经济成本是南非（SA）无法获得充分医疗保健的一个公认原因。描述南非医疗保健专业人员（HCP）对成本认识的数据很少。他们对医疗保健成本的认识提高可能会提高效率并减少浪费性支出。
评估南非医疗保健专业人员对医疗保健成本的了解，确定影响成本意识的因素，并确定接受调查的医疗保健专业人员在学习期间或执业的任何阶段是否接受过与成本管理相关的培训。
本横断面调查通过标准化问卷进行。在一家大型三级学术医院工作的医疗保健专业人员被要求回答一份匿名标准化问卷，旨在确定他们对常见医院项目和检查成本的认识。成本准确性通过评估估计成本与真实成本的对数偏差来确定，值>0和<0分别代表高估和低估。如果对数偏差的绝对值<0.2，则成本估计被认为是正确的。评估了参与者对成本信息可用性对其执业潜在影响的态度。
成本估计准确性的总体水平较低（平均值0.60；标准差1.99），不同项目之间差异很大。较便宜的项目更有可能被高估，而昂贵的项目则更有可能被低估。大多数参与者表示，成本意识教育不是他们培训或执业的一部分（84.5%），并且他们希望成本信息能够随时可得（92.2%）。84%的参与者认为成本信息不会对患者护理产生负面影响。
使用与真实成本的百分比偏差作为评估成本意识的方法会产生高估偏差，这对于便宜项目更为相关，因为这些项目的高估更为常见。我们建议使用估计成本与真实成本的对数偏差作为评估成本估计准确性的方法。医疗保健专业人员对其执业中常用的一次性用品、检查和药物的成本了解有限，并且希望能够随时获得成本信息。应注意提高南非医院医疗保健专业人员的成本意识。
