Cost of Injury
Cost of Injury
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Background to Tables
These tables were prepared by Jerry Moller in June 1998 using data supplied by the National Injury Surveillance Unit and a methodology developed by the Monash University Accident Research Centre (MUARC) for estimating injury costs. The methods used by both MUARC and Jerry Moller to estimate the cost of injury
are outlined below:
The work undertaken by MUARC on the cost of injury was funded by the Department of Human Services in Victoria. The full report on the project appears in the following publication:
Watson, WL & Ozanne-Smith, J. The Cost of Injury to Victoria. December 1997. Monash University Accident Research Centre. Report No. 124.
The framework for estimating the total cost in the Victorian study consists of:
- costs relating to the treatment of injury (direct costs),
- costs relating to the loss, or partial loss, to society of the productive
efforts (both paid and unpaid) of injury victims and care-givers in the case of
children (indirect costs).
The actual expenditure related to the injury
These include:
- medical and non-medical costs such as hospital (inpatient and Emergency Department),
- medical (general & specialist services) and rehabilitation (rehabilitation services, aids and equipment) costs associated with the treatment of injury. Other direct costs include
- ambulance transport,
- pharmaceuticals, and
- treatment by health professionals other than medical doctors.
They may also include:
cost of caring for an injured person at home such as attendant care or visits by a nursing service. No attempt was made to value the services of family and friends (beyond the productive loss to caregivers of child injury victims) who care for the injured, because of the lack of data available in relation to this
area. However, this 'informal care' cost is likely to be significant as indicated by case studies included in the study by Rice et al (1989).
Legal costs and property damage are excluded because they are costs associated with the injury event rather than the injury itself and information about these costs is not available for all causes of injury. That is, the costs are injured person- rather that event- or accident-based. While data for property damage, for example, is probably available for road traffic accidents and house fires in Victoria, it is not available for other injury events. As indicated by the BTCE (1992) study, property damage can account for a significant proportion of the total cost of an injury event (30%).
Represent the value of lost output due to reduced productivity caused by injury and any resultant disability (morbidity) and losses due to premature death (mortality). Loss or partial loss of future production has been estimated in terms of earnings and labour on-costs of injury victims, the productive but unpaid contribution of victims to their households and communities and the productive time lost by caregivers of child injury victims. Compensation costs relating to pain and suffering have not been included.
The aforementioned factors comprise the framework for the estimation of injury-related costs.
The estimate of the total cost of injury to Victoria in 1993/94 has been generated from the actual or estimated incidence of injury in that year. The estimates will therefore be affected by the accuracy or otherwise of these data. Costs are estimated for three levels of injury severity : fatalities, hospitalised injuries and non-hospitalised injuries. It is reasonable to expect that injury data becomes less reliable as the degree of injury severity decreases since many moderate to minor injuries are self-treated or treated by
allied health professionals. As mentioned in the previous chapter, such cases are not identified in the current injury surveillance systems. While the individual cost of such injuries will generally be small, their number is likely to be large and therefore their aggregate cost substantial, resulting in an under-estimation of the total cost of injury.
Payments data have been used as surrogates for resource costs. This approach is commonly used in the cost-of-illness literature (Rice et al., 1989). It is recognised, however, that due to market imperfections in the health sector, payments may not reflect costs completely accurately.
Comprehensive payment data (on deaths, hospitalised and non-hospitalised cases) has been provided for this study by the Victorian WorkCover Authority (VWA) and the Transport Accident Commission (TAC). Contained in their databases is information about a range of direct costs including hospital, medical, allied health and rehabilitation treatment as well as attendant care, and ambulance, etc. Information about income support, lump sum payments and long term outcomes is also available. All payments made by these authorities to December 31, 1996 in relation to transport accident and occupational injuries that occurred in 1993/94 have been included in the average costs used for each payment category in this study. While there will still be further costs incurred for those cases which have resulted in permanent or long-term disability, it is assumed that the major part of treatment costs have been incurred during this period.
Very little work has been done in Australia on the long-term cost of injury. For the purpose of this study an estimate of the direct treatment costs for severe spinal cord injury, for which incidence and cost data is available, has been included. An estimate of nursing home costs (based on discharges to nursing homes from acute care hospitals) has also been included in the hospitalisation costs. Morbidity cost estimates for hospitalised patients include those for totally and permanently incapacitated persons, severe spinal cord injury as well as nursing home admissions (adjustments being made to avoid double-counting).
For non-hospitalised injury cases:
the cost data supplied by the TAC and the VWA were supplemented by information about service fees from the Health Insurance Commission's Medicare & Pharmaceutical Benefits Statistical Tables.
Data used in establishing lost production values have been derived from Australian Bureau of Statistics publications, on-line information service and from the BTCE (1992) study on the cost of transport accidents in Australia.
Australian figures for 1995-96 were multiplied by each of the cells in the Victorian tables (Appendix D, `Cost per injured person' columns) to arrive at tables detailing the estimated cost of injury in $millions by age and major cause of injury. Where no information was available for Victoria, figures were interpolated across and down columns to come up with a unit cost.
The major cause of injury categories, which are based on groupings of the ICD
E-Codes, are as follows:
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