Healthcare in Singapore

My father-in-law has been going through 10 weeks of weekly intravenous injections of iron-sucrose injections in an attempt to raise his heamoglobin level. This was done partly to increase his effort tolerance, as he was finding it difficult to walk short distances without feeling breathless. This is done on top of weekly erythropoietin injections.

Intravenouse treatment at home

This is the trend of his haemoglobin from January to April 2011 :

24th January – 7.8 g/dL
9th Match – 8.4 g/dL
28th April – 12.1 g/dL

Total improvement in haemoglobin level is 4.3 g/dL.

This is the breakdown of costs to for this cycle of care :

Cost of IV drug – $240 for 10 vials of iron-sucrose
Cost of IV accessories – $440 for IV accessories
Cost of IV procedure done by nurses in the hospital’s outpatient clinic – $500 ( Cost by doctors’ home visits is approximately $2000 ) ( I practically did it for nothing for my father-in-law )
Cost of transport to the hospital and away from work for caregiver (dependent on type of transport and caregiver’s work) ( omit this if procedure is done by home-visiting doctors ) – $4000 ( taking my type of transport and work as an example )

Total cost ( if procedure is done in hospital ) – $5180
Total cost ( if procedure is done at home ) – $2680

So cost-effectiveness of intravenous iron-sucrose medication to improve haemoglobin level in my father-in-law was :

5180 / 4.3 = $1205 per 1 g/dL increase in haemoglobin if procedures performed in hospital
OR
2680 / 4.3 = $623 per 1 g/dL increase in haemoglobin if procedures performed at home

So overall, the family is happy with the results of the intravenous treatment. The question is, at what patient’s comfort and cost?

Recent studies from the USA shows that number of adverve events faced by patients during their stay in hospitals is actually higher than previously reported.

The study, in April’s Health Affairs, echoes two reports issued in November 2010 that showed rates of adverse events hovering near 25% among hospitalized Medicare patients nationwide and at 10 North Carolina hospitals.

In a survey released March 31, patients are scared of medical mishaps. Nearly 60% of adults polled by the Consumer Reports National Research Center believe medical errors are common in hospitals, and nearly half said serious harm is common. Nearly 80% of patients said they feared contracting an infection in a hospital, 71% were worried about medication errors and 65% were scared of surgical mistakes.

The vast majority of the adverse events identified in the Health Affairs study — 93% — required medical intervention but did not permanently injure or kill the patient. Most were medication-related or nosocomial ( hospital-acquired, ie inadequate staff hygiene ) infections.

The NEJM study said 63% of the adverse events that reviewers identified could have been avoided.

This is the breakdown of the costs of the care cycle for my father-in-law’s medical condition of low blood content, which required a recent diagnostic and treatment intervention to find out the cause.

Day Surgery Facility Charge $ 53.27
Consumables $ 218.74
Laboratory Investigations $ 269.00
Non Standard Medications $ 12.04
Standand Medications $ 28.32
Renal Dialsys (Peritoneal) $ 30.00
Minor Surgical Procedure $ 66.00
(Ligation of 3 internal piles)
Surgical Procedure $ 1,425.18
Gastroscopy Consumables Package $ 80.80

Total Charges $ 2,183.35

One will think that this is a reasonable amount for the intervention that he went through, and I agree. But the care cycle does not end there.

My father-in-law subsequently suffered a complication from new oral medications that he was discharged with after the intervention. This required a medical professional ( in this case me ) to step in to mitigate the problems. The prices here are an estimate as I obviously did not charge my father-in-law.

2 Home Visits ( one at 5am ) $ 400
Intravenous Dextrose drip for 24 hours $ 50
(provided caregiver changes dextrose bottles on their own every 6 hours)
Total charges $ 450

So the total cost is $ 2,183.35 + $ 450 = $ 2,633.35

The care cycle would end here if he was not admitted into the hospital through the emergency department. But for most families, the care cycle would have continued because they would not have a medical professional in the family to take charge of the situation arising from the side effects of those oral medications.

This method will be a good way to compare the value of any intervention by any healthcare provider to any patient. Only by comparing the total charges over the whole care cycle of a medical condition and its interventions can we truely choose the best for ourselves and our families.