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Purpose of Study

Economic Evaluation of Flying Doctor Services in KZN – South Africa Emmanuelle Daviaud, Mickey Chopra Health Systems Research Unit, Medical Research Council. Cape Town, South Africa. Purpose of Study. Access to clinical specialist care is uneven and very often poor in developing countries

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Purpose of Study

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  1. Economic Evaluation of Flying Doctor Services in KZN – South AfricaEmmanuelle Daviaud, Mickey ChopraHealth Systems Research Unit, Medical Research Council. Cape Town, South Africa

  2. Purpose of Study Access to clinical specialist care is uneven and very often poor in developing countries Two possible approaches to increase access Getting the patients to the specialists (referral option) Getting the specialists to the patients (outreach option) Policy makers require a good understanding of the opportunity costs incurred by each form of intervention. We therefore conducted an economic evaluation of a air outreach programme in a rural province in South Africa in 2004.

  3. Outreach: the Flying Doctor Service Run by NGO: Red-Cross AMS in collaboration with DoH DoH staff & volunteers (NGO, private sector) are flown for 1 day to rural district hospitals. There they: See pre-selected patients in OPD and perform Surgery. Provide training and support for junior doctors in rural hospitals Update protocols, check quality of care Each hospital visited at least once a month Air service provides cold chain delivery system for blood, vaccines, drugs, labs samples, etc

  4. The questions What is the cost per patient of the actual outreach service ? What would be the cost with a referral-based model for delivering similar level of service? Economic analysis, not clinical analysis Benefit for the patient in terms of access and decreased cost, whilst undeniable, is not quantified in this study.

  5. Methodology 2004 F.D.S. activity and cost to the public sector were analysed. Activity in regional and tertiary hospitals which would have taken place, if outreach was not available, was quantified and costed. Cost of A & B were compared. Sensitivity analysis carried out

  6. Modelling Referral Option Survey of Clinicians: From patients seen in Outreach and per clinical type, what proportions would apply if Referral-based model: % would not receive service % would be referred to regional & to tertiary hospitals % of those referred who would require ambulance transport

  7. Activity

  8. Costs Outreach

  9. Costs Referral Model

  10. RESULTS

  11. Outreach Activity in 2004 Over 19 000 patients were seen 85 were referred on to regional/tertiary hosps 451 patients had surgery 457 clinics were held in 30 hospitals 672 staff attended CPR course 2176 attended special lectures

  12. Type of consultations

  13. Volunteer Staff

  14. Patients Distribution with Referral Model

  15. Activity Referral Model

  16. Comparing Costs

  17. Sensitivity Analysis

  18. DISCUSSION Outreach based model cheaper for higher coverage Well-suited for higher density rural areas Requires good management of outreach to ensure that: Outreach staff is reminded of duty days Patients are pre-selected in receiving hospitals Both Access AND Efficiency addressed

  19. What was not quantified Impact of training of junior doctors Impact of quality monitoring in rural hosps Impact of personal contact between consultants and junior staff Impact on patients (cost and proximity) Savings on cold chain transport

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