Patient estimates of healthcare costs in trauma and orthopaedics.

Aim: The cost of treating trauma and musculoskeletal conditions per head of population in Wales in 2007-2010 increased from £183 to £236, representing an increase in National Health Service total expenditure of 13.11 %. This study was set up to determine whether the public is aware of the general costs of treatment within the trauma and orthopaedic department.

Method: Patients completed a questionnaire asking them what they thought the cost was for common orthopaedic treatments, investigations and implants. This questionnaire was completed whilst they were waiting to be seen in clinic.

Results: We had 183 completed questionnaires from patients with an average age of 43.47 years (range, 18-85 years). All patients were members of the public, with no previous experience of NHS work or costing. The inter-rater reliability was 0.39(95 % CI, 0.178-0.559). A product was accurately assessed if the estimates were between 50 and 200 % of the true cost. Costs of arm slings and crutches were well estimated by >80 % of the respondents. Approximately 60 % accurately estimated the cost of a fracture clinic visit, hospital transport and physiotherapy and lower limb plaster. Only 22.5 % accurately estimated the cost of a knee X-ray with 37.6 % overestimating the cost by more than tenfold. Other expenses that were underestimated by patients were the costs of a total hip replacement (in 58.3 %), fixation of an ankle fracture (in 32.2 %) and an overnight inpatient stay (in 10.9 %).

Conclusion: Whilst the costs of physical products were well estimated by our cohort of patients, the costs of less tangible products, such as radiology and operations, were poorly estimated. Our study shows that there is a poor public perception of the true cost for investigation and operative treatment of common trauma and orthopaedic conditions.