Zulu Tryphine, Heap Marion, Sinanovic Edina
Health Economics Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa.
Health and Human Rights Programme, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa.
PLoS One. 2017 Dec 22;12(12):e0189983. doi: 10.1371/journal.pone.0189983. eCollection 2017.
The World Health Organisation estimates disabling hearing loss to be around 5.3%, while a study of hearing impairment and auditory pathology in Limpopo, South Africa found a prevalence of nearly 9%. Although Sign Language Interpreters (SLIs) improve the communication challenges in health care, they are unaffordable for many signing Deaf people and people with disabling hearing loss. On the other hand, there are no legal provisions in place to ensure the provision of SLIs in the health sector in most countries including South Africa. To advocate for funding of such initiatives, reliable cost estimates are essential and such data is scarce. To bridge this gap, this study estimated the costs of providing such a service within a South African District health service based on estimates obtained from a pilot-project that initiated the first South African Sign Language Interpreter (SASLI) service in health-care.
The ingredients method was used to calculate the unit cost per SASLI-assisted visit from a provider perspective. The unit costs per SASLI-assisted visit were then used in estimating the costs of scaling up this service to the District Health Services. The average annual SASLI utilisation rate per person was calculated on Stata v.12 using the projects' registry from 2008-2013. Sensitivity analyses were carried out to determine the effect of changing the discount rate and personnel costs.
Average Sign Language Interpreter services' utilisation rates increased from 1.66 to 3.58 per person per year, with a median of 2 visits, from 2008-2013. The cost per visit was US$189.38 in 2013 whilst the estimated costs of scaling up this service ranged from US$14.2million to US$76.5million in the Cape Metropole District. These cost estimates represented 2.3%-12.2% of the budget for the Western Cape District Health Services for 2013.
In the presence of Sign Language Interpreters, Deaf Sign language users utilise health care service to a similar extent as the hearing population. However, this service requires significant capital investment by government to enable access to healthcare for the Deaf.
世界卫生组织估计，致残性听力损失约为5.3%，而一项针对南非林波波省听力障碍和听觉病理学的研究发现，患病率接近9%。虽然手语翻译人员（SLIs）改善了医疗保健中的沟通难题，但对于许多使用手语的聋人和有致残性听力损失的人来说，他们负担不起。另一方面，在包括南非在内的大多数国家，卫生部门没有确保提供手语翻译人员的法律规定。为倡导为这类举措提供资金，可靠的成本估计至关重要，但此类数据稀缺。为弥补这一差距，本研究根据一个在医疗保健领域启动首个南非手语翻译（SASLI）服务的试点项目所获得的估计数据，估算了在南非一个地区卫生服务机构内提供此类服务的成本。
采用成分法从提供者角度计算每次SASLI辅助就诊的单位成本。然后，将每次SASLI辅助就诊的单位成本用于估算将该服务扩大到地区卫生服务机构的成本。使用2008 - 2013年项目登记册，在Stata v.12上计算每人每年的SASLI平均利用率。进行敏感性分析以确定改变贴现率和人员成本的影响。
2008 - 2013年，手语翻译服务的平均利用率从每人每年1.66次增加到3.58次，中位数为2次就诊。2013年每次就诊成本为189.38美元，而在开普敦都会区将该服务扩大的估计成本在1420万美元至7650万美元之间。这些成本估计占西开普地区卫生服务机构2013年预算的2.3% - 12.2%。
在手语翻译人员在场的情况下，使用手语的聋人利用医疗保健服务的程度与听力正常人群相似。然而，这项服务需要政府进行大量资本投资，以使聋人能够获得医疗保健服务。
