The tale of the $1000 ankle sprain
Mr. X hobbles into an A&M clinic at 7pm on a Sunday night. He twisted his ankle playing soccer the previous day and it is still quite swollen and painful. His job involves standing all day and his main motivation for attending is to get a few days off work.
He fills in an ACC form – I am reliably informed that for the form to be processed, assessed, the claim accepted and a case manager assigned costs ACC about $300 – I presume this is an average figure (i.e. this particular form may cost less)
He sees a triage nurse then a doctor – ACC is charged $38 for this.
The doctor orders an Xray of the ankle and foot – ACC is charged $112
There is no fracture but the doctor decides the sprain should be immobilized for a few weeks – he wants to use a simple air-splint for this but ACC won’t pay the $60 fee unless it is prescribed by a specialist. Accordingly, he sends a referral to the specialist and, in the meantime uses a back slab of plaster of paris to immobilize the ankle – ACC is charged $143 for the temporary back slab and loan of crutches.
The doctor refers Mr. X for physiotherapy – ACC is billed $390 ($39 per session x 10)
Mr. X. sees a specialist – ACC is billed $78 and $60 for the air-splint
Mr X. returns to the A&M to have his back slab taken off – ACC is billed $38
Total ACC cost for Mr. X and his moderately sprained ankle = $1,159
A sprained ankle is the second commonest injury to present to an A&M or ED (cut finger is the most common). I have used a worst case scenario here so the average sprained ankle will be less than this (I estimate about $650 on average). My point here is that the vast majority of ankle sprains do not require any of this intervention. If you can walk around on the ankle and the pain is improving slowly (it can be really painful for the first couple of days), the chances are that you need nothing but a couple of paracetamol and some ice. Unfortunately there is no incentive not to have all this unnecessary treatment.
- The patient pays little (or nothing in an ED) of the bill
- The doctor will get endless paperwork to do if he misses even the smallest fracture – so he will Xray almost everything.
- In an A&M, the doctors are encouraged to Xray, as the radiologist makes more money and is therefore unlikely to shut down (which would shut down the A&M)
- Most injuries ACC pays for are fairly trivial and are simply not worth checking up on.
- ACC provides more than half of the income of A&Ms – there is every incentive for private clinics and GPs to over-treat their patients.
And this is only one of the many reasons why ACC is $2.5 billion short. At least $2.5 billion…